1174642698 NPI number — JUAN JOEL GARZA, MD PA

Table of content: KACIE DAWN ALTIZER (NPI 1942824248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174642698 NPI number — JUAN JOEL GARZA, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUAN JOEL GARZA, MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174642698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 E. RIDGE ROAD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-630-5522
Provider Business Mailing Address Fax Number:
956-926-4350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2310 N. ED CAREY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-428-5522
Provider Business Practice Location Address Fax Number:
956-926-4350
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
NORMALINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIAL COORDINATOR
Authorized Official Telephone Number:
956-430-3413

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  K7157 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00311777 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com