Healthcare Provider Details

I. General information

NPI: 1962706325
Provider Name (Legal Business Name): JOSUE R REYNA CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSHUA REYNA CNIM

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 EXCHANGE AVE SUITE C
SCHERTZ TX
78154
US

IV. Provider business mailing address

P.O. BOX 592442
SAN ANTONIO TX
78259
US

V. Phone/Fax

Practice location:
  • Phone: 210-566-2333
  • Fax: 210-566-1330
Mailing address:
  • Phone: 210-566-2333
  • Fax: 210-566-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number166979
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number420
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: