1417584582 NPI number — DR. NANCY DE LA GARZA MADIA MD

Table of content: DR. NANCY DE LA GARZA MADIA MD (NPI 1417584582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417584582 NPI number — DR. NANCY DE LA GARZA MADIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADIA
Provider First Name:
NANCY
Provider Middle Name:
DE LA GARZA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE LA GARZA DE LA O
Provider Other First Name:
NANCY
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417584582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1604 HOSPITAL PKWY STE 407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76022-6932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-573-3855
Provider Business Mailing Address Fax Number:
833-973-4597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 E STATE HIGHWAY 114 STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-5256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-573-3855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  V0465 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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