Provider Demographics
NPI:1194225797
Name:PINA, REYNALDO EDEN JR (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:EDEN
Last Name:PINA
Suffix:JR
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 CALLAGHAN RD APT 808
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2877
Mailing Address - Country:US
Mailing Address - Phone:956-500-6336
Mailing Address - Fax:
Practice Address - Street 1:7575 CALLAGHAN RD APT 808
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2877
Practice Address - Country:US
Practice Address - Phone:956-500-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist