Healthcare Provider Details

I. General information

NPI: 1457648917
Provider Name (Legal Business Name): ALEXANDRA GARZA FLORES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 8TH AVE STE 200
FORT WORTH TX
76104-2500
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-2170
  • Fax: 817-335-8277
Mailing address:
  • Phone: 682-885-1855
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number248954
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberR3848
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: