Provider Demographics
NPI:1679991285
Name:REYNOSO, LUZ (LPN)
Entity type:Individual
Prefix:MS
First Name:LUZ
Middle Name:
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CALLE TAURO
Mailing Address - Street 2:URB. LOS ANGELES
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-1663
Mailing Address - Country:US
Mailing Address - Phone:939-282-8759
Mailing Address - Fax:
Practice Address - Street 1:15 CALLE TAURO
Practice Address - Street 2:URB. LOS ANGELES
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-1663
Practice Address - Country:US
Practice Address - Phone:939-282-8759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR61214-P164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse