Provider Demographics
NPI:1598757577
Name:MAKABALI, REYNALDO LIMPIN (MD)
Entity type:Individual
Prefix:DR
First Name:REYNALDO
Middle Name:LIMPIN
Last Name:MAKABALI
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 1:2426 W 8TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3840
Mailing Address - Country:US
Mailing Address - Phone:213-389-9595
Mailing Address - Fax:213-389-2556
Practice Address - Street 1:2426 W 8TH ST STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3840
Practice Address - Country:US
Practice Address - Phone:213-389-9595
Practice Address - Fax:213-389-2556
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51157208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A511570Medicaid
CACB208967OtherPTAN
CACB208967OtherPTAN
CA00A511570Medicaid