Provider Demographics
NPI:1962706325
Name:REYNA, JOSUE R (CNIM)
Entity type:Individual
Prefix:MR
First Name:JOSUE
Middle Name:R
Last Name:REYNA
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:MR
Other - First Name:JOSHUA
Other - Middle Name:
Other - Last Name:REYNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNIM
Mailing Address - Street 1:P.O. BOX 592442
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259
Mailing Address - Country:US
Mailing Address - Phone:210-566-2333
Mailing Address - Fax:210-566-1330
Practice Address - Street 1:524 EXCHANGE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154
Practice Address - Country:US
Practice Address - Phone:210-566-2333
Practice Address - Fax:210-566-1330
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX166979164X00000X
420246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No164X00000XNursing Service ProvidersLicensed Vocational Nurse