Provider Demographics
NPI:1619278801
Name:REONIDA, LLC DBA RENATO B MASILUNGAN, MD
Entity Type:Organization
Organization Name:REONIDA, LLC DBA RENATO B MASILUNGAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:BRIONES
Authorized Official - Last Name:MASILUNGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-474-8989
Mailing Address - Street 1:222 E PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3342
Mailing Address - Country:US
Mailing Address - Phone:619-474-8989
Mailing Address - Fax:619-474-2112
Practice Address - Street 1:222 E PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3342
Practice Address - Country:US
Practice Address - Phone:619-474-8989
Practice Address - Fax:619-474-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADU068AMedicare UPIN