Healthcare Provider Details

I. General information

NPI: 1750658647
Provider Name (Legal Business Name): CRYSTAL GARZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 S PORT AVE
CORPUS CHRISTI TX
78405-2301
US

IV. Provider business mailing address

1660 S STAPLES ST STE 150
CORPUS CHRISTI TX
78404-3156
US

V. Phone/Fax

Practice location:
  • Phone: 361-883-1879
  • Fax: 361-883-1881
Mailing address:
  • Phone: 361-800-8155
  • Fax: 361-882-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP3887
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: