1689123218 NPI number — MISS DANIELA GARZA PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689123218 NPI number — MISS DANIELA GARZA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARZA
Provider First Name:
DANIELA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1689123218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2102 TREASURE HILLS BLVD.
Provider Second Line Business Mailing Address:
#3.144.11
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78550-8736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-296-1437
Provider Business Mailing Address Fax Number:
956-296-6842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3804 S JACKSON RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-6683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-296-3021
Provider Business Practice Location Address Fax Number:
956-296-3020
Provider Enumeration Date:
09/23/2016

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: 363A00000X , with the licence number:  PA10550 , 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: 374647101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: H08HN40201 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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