Healthcare Provider Details

I. General information

NPI: 1699512160
Provider Name (Legal Business Name): IDALIA REYNA APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 BUDDY OWENS AVE STE 300
MCALLEN TX
78504-6545
US

IV. Provider business mailing address

3220 BUDDY OWENS AVE STE 300
MCALLEN TX
78504-6545
US

V. Phone/Fax

Practice location:
  • Phone: 956-627-5245
  • Fax: 956-627-5246
Mailing address:
  • Phone: 956-627-5245
  • Fax: 956-627-5246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1168760
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: