1962706325 NPI number — MR. JOSUE R REYNA CNIM

Table of content: MR. JOSUE R REYNA CNIM (NPI 1962706325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962706325 NPI number — MR. JOSUE R REYNA CNIM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNA
Provider First Name:
JOSUE
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CNIM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REYNA
Provider Other First Name:
JOSHUA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNIM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962706325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 592442
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-566-2333
Provider Business Mailing Address Fax Number:
210-566-1330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
524 EXCHANGE AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SCHERTZ
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-566-2333
Provider Business Practice Location Address Fax Number:
210-566-1330
Provider Enumeration Date:
12/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164X00000X , with the licence number:  166979 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZE0600X , with the licence number: 420 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com