Provider Demographics
NPI:1487320545
Name:REYNA-RODRIGUEZ, ARIANNA EDITH
Entity type:Individual
Prefix:
First Name:ARIANNA
Middle Name:EDITH
Last Name:REYNA-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARIANNA
Other - Middle Name:EDITH
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1653 MCLEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-6612
Mailing Address - Country:US
Mailing Address - Phone:651-703-2262
Mailing Address - Fax:
Practice Address - Street 1:731 BIELENBERG DR # 102-104
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55125-1700
Practice Address - Country:US
Practice Address - Phone:612-445-8324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician