Provider Demographics
NPI:1609515618
Name:DIAZ, REYNA (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:REYNA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:REYNA
Other - Middle Name:ALBOR
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1621 LAKEVILLE DR STE 304
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2694
Mailing Address - Country:US
Mailing Address - Phone:281-305-0411
Mailing Address - Fax:
Practice Address - Street 1:1621 LAKEVILLE DR STE 304
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2694
Practice Address - Country:US
Practice Address - Phone:281-305-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX718743163W00000X
TXL-65160163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse