Provider Demographics
NPI:1295735553
Name:ALONSO, REYNALDO HILARIO (MD)
Entity type:Individual
Prefix:DR
First Name:REYNALDO
Middle Name:HILARIO
Last Name:ALONSO
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 1:4950 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5822
Mailing Address - Country:US
Mailing Address - Phone:800-954-8000
Mailing Address - Fax:
Practice Address - Street 1:2426 EASTCHESTER RD
Practice Address - Street 2:204
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5947
Practice Address - Country:US
Practice Address - Phone:718-231-7872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191962-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0004611253OtherAETNA
0482499OtherAETNA HMO
NY17J072OtherBC/BS COMMERCIAL
NY1P0001OtherPHS
NY2505001OtherGHI
NY133884701OtherCOMMERCIAL
NY191962-NYOther1199 BENEFITS FUND
NY01654888Medicaid
NYGP292OtherOXFORD
0622006OtherCIGNA
NY191962OtherHIP HEALTH PLANS OF NY
NY17J072OtherBC/BS COMMERCIAL
NY191962OtherHIP HEALTH PLANS OF NY
GA1101330337Medicare ID - Type UnspecifiedPALMETTO GBA-RAILROAD MCR