Provider Demographics
NPI:1821861642
Name:REYNA, TOMMY LEE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:LEE
Last Name:REYNA
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 CANO ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-6923
Mailing Address - Country:US
Mailing Address - Phone:210-396-0503
Mailing Address - Fax:
Practice Address - Street 1:409 CANO ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-6923
Practice Address - Country:US
Practice Address - Phone:210-396-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX972242163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency