Provider Demographics
NPI:1114100302
Name:REINA, LUDMILA
Entity Type:Individual
Prefix:
First Name:LUDMILA
Middle Name:
Last Name:REINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUDMILA
Other - Middle Name:
Other - Last Name:THYGANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40347
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87196-0347
Mailing Address - Country:US
Mailing Address - Phone:505-765-1153
Mailing Address - Fax:
Practice Address - Street 1:8201 GOLF COURSE RD NW
Practice Address - Street 2:C-2A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5842
Practice Address - Country:US
Practice Address - Phone:505-349-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4497225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist