Provider Demographics
NPI:1932233871
Name:MALONJAO, REYNALDO G (LDO)
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:G
Last Name:MALONJAO
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6079 BRANDT PIKE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4014
Mailing Address - Country:US
Mailing Address - Phone:937-237-8669
Mailing Address - Fax:937-237-9019
Practice Address - Street 1:6079 BRANDT PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-4014
Practice Address - Country:US
Practice Address - Phone:937-237-8669
Practice Address - Fax:937-237-9019
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS5371156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist