MEDICARE: MRS. REYNITA ROMUSOD SAGON-ALCISTO AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AU2550	CA

General Provider Information

NPI Number	:	1598953093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REYNITA ROMUSOD SAGON-ALCISTO AU.D.

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD STE 1620
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4007
Country	:	US
Telephone Number	:	213-423-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 W 3RD ST
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1944
Country	:	US
Telephone Number	:	213-353-7005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	03/05/2026

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