Provider Demographics
NPI:1346747391
Name:ATILLO, RONALD MAR TENORIO (AG-ACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:RONALD MAR
Middle Name:TENORIO
Last Name:ATILLO
Suffix:
Gender:M
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 PARADISE WAY
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3060
Mailing Address - Country:US
Mailing Address - Phone:747-257-9053
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:800-926-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008863207RN0300X, 363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2000070078OtherAMERICAN ASSOCIATION OF CRITICAL CARE NURSES
CA768953OtherBOARD OF NURSING
CA95008863OtherCALIFORNIA BOARD OF NURSING
CA95008863OtherFURNISHING NUMBER