Healthcare Provider Details

I. General information

NPI: 1619278801
Provider Name (Legal Business Name): REONIDA, LLC DBA RENATO B MASILUNGAN, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E PLAZA BLVD
NATIONAL CITY CA
91950-3342
US

IV. Provider business mailing address

222 E PLAZA BLVD
NATIONAL CITY CA
91950-3342
US

V. Phone/Fax

Practice location:
  • Phone: 619-474-8989
  • Fax: 619-474-2112
Mailing address:
  • Phone: 619-474-8989
  • Fax: 619-474-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA29679
License Number StateCA

VIII. Authorized Official

Name: RENATO BRIONES MASILUNGAN
Title or Position: OWNER
Credential: MD
Phone: 619-474-8989