Provider Demographics
NPI:1962845685
Name:JAVIER-REYNA, MONICA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MARIE
Last Name:JAVIER-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 1:801 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-2276
Mailing Address - Country:US
Mailing Address - Phone:956-787-8915
Mailing Address - Fax:956-787-2021
Practice Address - Street 1:801 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589
Practice Address - Country:US
Practice Address - Phone:956-787-8915
Practice Address - Fax:956-787-2021
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08332363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343547YLALOtherMEDICARE
TX333496301Medicaid
TXPA08332OtherLICENSE