Basic Information
| Provider Information | |||||||||
| NPI: | 1346747391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATILLO | ||||||||
| FirstName: | RONALD MAR | ||||||||
| MiddleName: | TENORIO | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | AG-ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 PARADISE WAY | ||||||||
| Address2: | |||||||||
| City: | NATIONAL CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919503060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7472579053 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 W ARBOR DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921039000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009268273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2018 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 95008863 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 363LG0600X | 95008863 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2100X | 95008863 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 2000070078 | 01 | CA | AMERICAN ASSOCIATION OF CRITICAL CARE NURSES | OTHER | 768953 | 01 | CA | BOARD OF NURSING | OTHER | 95008863 | 01 | CA | CALIFORNIA BOARD OF NURSING | OTHER | 95008863 | 01 | CA | FURNISHING NUMBER | OTHER |