Provider Demographics
NPI:1689813693
Name:DR LUIS REYNOSO PA
Entity Type:Organization
Organization Name:DR LUIS REYNOSO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:REYNOSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-425-7800
Mailing Address - Street 1:629 KAIMALI DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-0016
Mailing Address - Country:US
Mailing Address - Phone:956-425-7800
Mailing Address - Fax:956-425-7801
Practice Address - Street 1:629 KAIMALI DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-0016
Practice Address - Country:US
Practice Address - Phone:956-495-7220
Practice Address - Fax:956-425-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG36652Medicare UPIN