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MDR 040501991289

This document is a Member Data Record from the Philippine Health Insurance Corporation providing basic information about a member. It includes the member's PhilHealth Identification Number, name, date of birth, address, employer information, and indicates they have no dependents listed. The record serves to verify the member's eligibility for health insurance coverage through PhilHealth and provides important details about their coverage period and category.

Uploaded by

REZEL JOHN MAYRENA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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75 views1 page

MDR 040501991289

This document is a Member Data Record from the Philippine Health Insurance Corporation providing basic information about a member. It includes the member's PhilHealth Identification Number, name, date of birth, address, employer information, and indicates they have no dependents listed. The record serves to verify the member's eligibility for health insurance coverage through PhilHealth and provides important details about their coverage period and category.

Uploaded by

REZEL JOHN MAYRENA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION


Corporate Action Center Hotline - (02) 441-7442
www.philhealth.gov.ph

MEMBER DATA RECORD


MEMBER BASIC INFORMATION
PhilHealth Identification Number (PIN) : 04-050199128-9 PhilSys Number :
Member Category : INDIRECT CONTRIBUTOR -
Sub-Category LISTAHANAN NHTS Coverage : EXISTING
Validity Period : 01/01/2023 - 12/31/2023

MAYRENA, REZEL JOHN


91-A SINAPANGAN NORTE, BANGAR LA UNION

Foreign Address : N/A Sex : MALE


Date of Birth : 01/20/1995
Place of Birth : BANGAR, LA UNION
Contact No. (Foreign) : N/A Civil Status : SINGLE
(Local) : N/A Tax Identification Number :

ENTITY INFORMATION
PhilHealth Number (PEN/POGN) : 400060003707
Name of Employer/Organized Group : DEPARTMENT OF HEALTH
hidden text
Business Address : SAN LAZARO COMPOUND RIZAL AVENUE, BGY 331, SANTA CRUZ NCR, CITY OF
hidden text MANILA, FIRST DISTRICT

Telephone Number : 632 6517800 Employment Status :


Tax Identification Number : N/A Date : N/A

DEPENDENT INFORMATION
PIN Surname Given Name Middle Name Sex Relation Date of Birth
*** NOTHING FOLLOWS ***

DENNIS B. ADRE
Regional Vice President
PRO - I Dagupan City

Paalala: Basahin ang nilalaman ng MDR. Kung may kulang o mali, ibalik agad upang maiwasto. Ingatan ang orihinal na kopya at huwag ibigay kahit kanino. Kung
sakaling gagamit at makikinabang ng benepisyo, magbigay ng kopya sa ospital. (Reminder: Read the contents of the MDR. Should there be any data discrepancies,
return it back to amend or rectify the error. Take good care of MDR and do not hand it over to anybody. Provide photocopy to hospital in case of confinement and
availment of benefits.)
This is a Member Portal System generated report. Signature is not required.
Jun 27, 2023 10:56 AM

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