Provider Demographics
NPI:1659383875
Name:UMALI, RENE (MD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:UMALI
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:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:IGO
Mailing Address - State:CA
Mailing Address - Zip Code:96047-0147
Mailing Address - Country:US
Mailing Address - Phone:530-227-1981
Mailing Address - Fax:
Practice Address - Street 1:8221 ZOGG MINE RD
Practice Address - Street 2:
Practice Address - City:IGO
Practice Address - State:CA
Practice Address - Zip Code:96047-0147
Practice Address - Country:US
Practice Address - Phone:530-227-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71638208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G716380Medicaid
CA00G716380Medicaid
CAG71638Medicare ID - Type UnspecifiedMEDICARE ID