Healthcare Provider Details

I. General information

NPI: 1972833085
Provider Name (Legal Business Name): AUDREY HELEN REYENGA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 08/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 N. DOWLEN RD
BEAUMONT TX
77706-1690
US

IV. Provider business mailing address

3460 N. DOWLEN RD
BEAUMONT TX
77706-1690
US

V. Phone/Fax

Practice location:
  • Phone: 409-838-0346
  • Fax: 409-839-3710
Mailing address:
  • Phone: 409-838-0346
  • Fax: 409-839-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA06635
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: