Provider Demographics
NPI:1851871891
Name:REYNA, JOSE CRUZ JR (BA)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:CRUZ
Last Name:REYNA
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:270 EL DORADO BLVD APT 403
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-2254
Mailing Address - Country:US
Mailing Address - Phone:956-373-5340
Mailing Address - Fax:
Practice Address - Street 1:806 MORGAN BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-5240
Practice Address - Country:US
Practice Address - Phone:956-428-6800
Practice Address - Fax:956-428-6805
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX384992355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38499Medicaid