Provider Demographics
NPI:1659361970
Name:BARRERA, ZOILA REYNA (PA-C)
Entity Type:Individual
Prefix:
First Name:ZOILA
Middle Name:REYNA
Last Name:BARRERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ZOILA
Other - Middle Name:REYNA
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:720 GOLDER AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4442
Mailing Address - Country:US
Mailing Address - Phone:432-337-3117
Mailing Address - Fax:
Practice Address - Street 1:720 GOLDER AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4442
Practice Address - Country:US
Practice Address - Phone:432-337-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03369363AS0400X, 363AM0700X
IL085.002951363AS0400X
GAGA005528363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123718204Medicaid
TX970026640OtherRAILROAD MEDICARE
TX970026640OtherRAILROAD MEDICARE
TX123718204Medicaid