Provider Demographics
NPI:1528077757
Name:MASILUNGAN, RENATO BRIONES (MD)
Entity type:Individual
Prefix:
First Name:RENATO
Middle Name:BRIONES
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 1:222 EAST PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950
Mailing Address - Country:US
Mailing Address - Phone:619-474-8989
Mailing Address - Fax:619-474-2112
Practice Address - Street 1:222 EAST PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-474-8989
Practice Address - Fax:619-474-2112
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A296790Medicaid
CAA29679Medicare ID - Type Unspecified
CA00A296790Medicaid