Basic Information
| Provider Information | |||||||||
| NPI: | 1295735553 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALONSO | ||||||||
| FirstName: | REYNALDO | ||||||||
| MiddleName: | HILARIO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4950 W SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900275822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009548000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2426 EASTCHESTER RD | ||||||||
| Address2: | 204 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104695947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182317872 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 10/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 191962-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0004611253 | 01 | NY | AETNA | OTHER | 0482499 | 01 | AETNA HMO | OTHER | 17J072 | 01 | NY | BC/BS COMMERCIAL | OTHER | 1P0001 | 01 | NY | PHS | OTHER | 2505001 | 01 | NY | GHI | OTHER | 133884701 | 01 | NY | COMMERCIAL | OTHER | 191962-NY | 01 | NY | 1199 BENEFITS FUND | OTHER | 01654888 | 05 | NY | MEDICAID | GP292 | 01 | NY | OXFORD | OTHER | 0622006 | 01 | CIGNA | OTHER | 191962 | 01 | NY | HIP HEALTH PLANS OF NY | OTHER |