1710287966 NPI number — MARTHA MARIE GARZA MD PA

Table of content: MRS. SUZANNE KAY ROBERTS LSW (NPI 1881036127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710287966 NPI number — MARTHA MARIE GARZA MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTHA MARIE 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:
1710287966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4499 MEDICAL DR
Provider Second Line Business Mailing Address:
STE. 151
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-614-3352
Provider Business Mailing Address Fax Number:
210-614-0945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4499 MEDICAL DR
Provider Second Line Business Practice Location Address:
STE. 151
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-3352
Provider Business Practice Location Address Fax Number:
210-614-0945
Provider Enumeration Date:
10/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GARZA
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-614-3352

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  G3384 , 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: 098243102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00F23D . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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