MEDICARE: TANIA ALEJANDRA REYNA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	25624	OK

General Provider Information

NPI Number	:	1316143621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA ALEJANDRA REYNA MD

Provider Business Mailing Address
First Line	:	1145 S UTICA AVE STE 110
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4013
Country	:	US
Telephone Number	:	918-579-3825
Fax Number	:	918-579-1262

Provider Business Practice Location Address
First Line	:	9001 S 101ST EAST AVE STE 190
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5799
Country	:	US
Telephone Number	:	918-579-3870
Fax Number	:	918-550-6736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2007
Last Update Date	:	09/04/2020

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