Healthcare Provider Details

I. General information

NPI: 1134424005
Provider Name (Legal Business Name): REONO BERTAGNOLLI A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10948 BIGGE ST STE A
SAN LEANDRO CA
94577-1121
US

IV. Provider business mailing address

930 RIDGEBROOK RD
SPARKS MD
21152-9481
US

V. Phone/Fax

Practice location:
  • Phone: 800-786-8015
  • Fax: 410-472-1754
Mailing address:
  • Phone: 800-786-8015
  • Fax: 410-472-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN C CUOMO
Title or Position: AUTHORIZED OFFICIAL, CFO
Credential:
Phone: 800-786-8015