Provider Demographics
NPI:1356929210
Name:OSORIO, REYNA GUADALUPE
Entity type:Individual
Prefix:
First Name:REYNA
Middle Name:GUADALUPE
Last Name:OSORIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 LEE ST.
Mailing Address - Street 2:BOX 800501
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0816
Mailing Address - Country:US
Mailing Address - Phone:434-924-5321
Mailing Address - Fax:434-244-4142
Practice Address - Street 1:1215 LEE ST.
Practice Address - Street 2:BOX 800501
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0816
Practice Address - Country:US
Practice Address - Phone:434-924-5321
Practice Address - Fax:434-244-4142
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0116040225390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program