Provider Demographics
NPI:1427011204
Name:LABOG, RENATO AGCAOILI (MD)
Entity Type:Individual
Prefix:DR
First Name:RENATO
Middle Name:AGCAOILI
Last Name:LABOG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:421 S SIERRA BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3534
Mailing Address - Country:US
Mailing Address - Phone:626-462-1892
Mailing Address - Fax:626-445-5024
Practice Address - Street 1:450 E HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3748
Practice Address - Country:US
Practice Address - Phone:626-462-1892
Practice Address - Fax:626-462-1466
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2012-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA829340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91231Medicare UPIN