Provider Demographics
NPI:1871925180
Name:REYNOSO, JAVIER ENRIQUE (PA)
Entity type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:ENRIQUE
Last Name:REYNOSO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3021 TORREON ST
Mailing Address - Street 2:
Mailing Address - City:HIDALGO
Mailing Address - State:TX
Mailing Address - Zip Code:78557-3552
Mailing Address - Country:US
Mailing Address - Phone:965-802-6297
Mailing Address - Fax:
Practice Address - Street 1:2901 W NOLANA AVE STE 10
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4896
Practice Address - Country:US
Practice Address - Phone:956-558-6090
Practice Address - Fax:956-558-6095
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08434363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX363AM0700XMedicaid
TX363AM0700XMedicaid