Provider Demographics
NPI:1508415837
Name:RICARDO REYNA III MD PLLC
Entity Type:Organization
Organization Name:RICARDO REYNA III MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:915-202-4913
Mailing Address - Street 1:9165 TURRENTINE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5942
Mailing Address - Country:US
Mailing Address - Phone:915-202-4913
Mailing Address - Fax:
Practice Address - Street 1:100 E SCHUSTER AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3556
Practice Address - Country:US
Practice Address - Phone:915-202-4913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty