Provider Demographics
NPI:1558685404
Name:REYNA, JAVIER GABRIEL (NP)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:GABRIEL
Last Name:REYNA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 MCPHERSON RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6402
Mailing Address - Country:US
Mailing Address - Phone:956-717-4629
Mailing Address - Fax:
Practice Address - Street 1:6801 MCPHERSON RD STE 213
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6443
Practice Address - Country:US
Practice Address - Phone:956-717-4629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX665900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner