Provider Demographics
NPI:1518460591
Name:RENO GERIATRICS LLC
Entity Type:Organization
Organization Name:RENO GERIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAGBOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-583-8799
Mailing Address - Street 1:PO BOX 19833
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2501
Mailing Address - Country:US
Mailing Address - Phone:775-432-6282
Mailing Address - Fax:775-432-6283
Practice Address - Street 1:5335 RENO CORPORATE DR STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2619
Practice Address - Country:US
Practice Address - Phone:757-432-6282
Practice Address - Fax:775-432-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty