Provider Demographics
NPI:1578617205
Name:MASILUNGAN, BENEDICTO GAONA (MD)
Entity Type:Individual
Prefix:DR
First Name:BENEDICTO
Middle Name:GAONA
Last Name:MASILUNGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 SO CEDROS AVE
Mailing Address - Street 2:#A
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075
Mailing Address - Country:US
Mailing Address - Phone:858-350-4414
Mailing Address - Fax:858-519-0002
Practice Address - Street 1:509 SO CEDROS AVE
Practice Address - Street 2:#A
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075
Practice Address - Country:US
Practice Address - Phone:858-350-4414
Practice Address - Fax:858-519-0002
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA053680208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A53680Medicare UPIN