Individual
LISA N REYNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
911 CASTROVILLE RD, SAN ANTONIO, TX 78237-3146
(210) 436-7402
(210) 436-7398
Mailing address
2961 MOSSROCK, SAN ANTONIO, TX 78230-5119
(210) 731-4800
(210) 731-4810
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA02060
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA02060
STATE LICENSE
TX
Enumeration date
04/27/2010
Last updated
07/31/2018
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