Provider Demographics
NPI:1548236391
Name:REINA, JASON BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:BENJAMIN
Last Name:REINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16061 DOCTORS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1479
Mailing Address - Country:US
Mailing Address - Phone:504-338-4746
Mailing Address - Fax:985-318-1005
Practice Address - Street 1:16061 DOCTORS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1479
Practice Address - Country:US
Practice Address - Phone:504-338-4746
Practice Address - Fax:985-318-1005
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD025097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1576441Medicaid
LA1576441Medicaid
LA4E3187560Medicare PIN