Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1053451732 |
---|---|
Provider Name | Mr. Paul Reyna |
First Address | Corpus Christi, TX 78415-1404 |
Second Address | Corpus Christi, TX 78415-1404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |