Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | LA7161 | LA |
N | 175L00000X | Homeopath | MT009009 | GA |
NPI | 1346693884 |
---|---|
Provider Name | Monica Reyna |
First Address | Cloutierville, LA 71416-2237 |
Second Address | Cloutierville, LA 71416-2237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2016 |
Last Update Date | 20/07/2016 |