Provider Demographics
NPI:1619557972
Name:REYNA, REANNA RENEE (PA)
Entity Type:Individual
Prefix:
First Name:REANNA
Middle Name:RENEE
Last Name:REYNA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 E SAN BENITO ST STE D
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-3482
Mailing Address - Country:US
Mailing Address - Phone:956-263-1830
Mailing Address - Fax:956-263-1836
Practice Address - Street 1:1673 E SAN BENITO ST STE D
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-3482
Practice Address - Country:US
Practice Address - Phone:956-263-1830
Practice Address - Fax:956-263-1836
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant