Healthcare Provider Details

I. General information

NPI: 1306079181
Provider Name (Legal Business Name): REYNALDO L. MAKABALI MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 W 8TH ST STE 104
LOS ANGELES CA
90057-3840
US

IV. Provider business mailing address

2426 W 8TH ST STE 104
LOS ANGELES CA
90057-3840
US

V. Phone/Fax

Practice location:
  • Phone: 213-389-9595
  • Fax: 213-389-2556
Mailing address:
  • Phone: 213-389-9595
  • Fax: 213-389-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA51157
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA51157
License Number StateCA

VIII. Authorized Official

Name: DR. REYNALDO LIMPIN MAKABALI
Title or Position: PRESIDENT
Credential: MD
Phone: 213-389-9595