1194046912 NPI number — DR. ROSA CORINA SUAREZ-REYNA OD

Table of content: DR. ROSA CORINA SUAREZ-REYNA OD (NPI 1194046912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194046912 NPI number — DR. ROSA CORINA SUAREZ-REYNA OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUAREZ-REYNA
Provider First Name:
ROSA
Provider Middle Name:
CORINA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194046912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6450 NW LOOP 410
Provider Second Line Business Mailing Address:
STE 115
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78238-4210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-691-4733
Provider Business Mailing Address Fax Number:
210-647-4741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6450 NW LOOP 410 STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78238-4210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-521-2085
Provider Business Practice Location Address Fax Number:
210-509-0962
Provider Enumeration Date:
06/15/2010

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: 152W00000X , with the licence number:  6958TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com