Healthcare Provider Details

I. General information

NPI: 1003088733
Provider Name (Legal Business Name): NOE DE LA GARZA P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CENTRAL BLVD.
BROWNSVILLE TX
78521-8872
US

IV. Provider business mailing address

PO BOX 8872
BROWNSVILLE TX
78526-8872
US

V. Phone/Fax

Practice location:
  • Phone: 956-639-3036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number2029122
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: