Healthcare Provider Details

I. General information

NPI: 1780642330
Provider Name (Legal Business Name): RACHEL REINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LAKEVIEW CIRCLE
COVINGTON LA
70433
US

IV. Provider business mailing address

150 LAKEVIEW CIRCLE
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 985-626-7546
  • Fax: 985-624-4960
Mailing address:
  • Phone: 985-626-7546
  • Fax: 985-624-4960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number025098
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: