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General NPI Number Information
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NPI Number | 1134424005
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Entity Type | Organization
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Legal Business Name | REONO BERTAGNOLLI A MEDICAL GROUP
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Dates
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Enumeration Date | 01/24/2011
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 10948 BIGGE ST STE A
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City | SAN LEANDRO
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State | CA
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Zip | 94577-1121
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Country | US
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Telephone | 800-786-8015
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Fax | 410-472-1754
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Provider Business Mailing Address
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Address Line | 930 RIDGEBROOK RD
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City | SPARKS
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State | MD
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Zip | 21152-9481
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Country | US
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Telephone | 800-786-8015
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Fax | 410-472-1754
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL, CFO
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Name | BRIAN C CUOMO
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Credential |
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Telephone | 800-786-8015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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