Healthcare Provider Details

I. General information

NPI: 1669615944
Provider Name (Legal Business Name): JESUS GUILLERMO GARCIA MAYORGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JESUS GUILLERMO GARCIA MD

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7877 WILLOW CHASE BLVD
HOUSTON TX
77070-5934
US

IV. Provider business mailing address

9601 SPUR 591
AMARILLO TX
79107-9606
US

V. Phone/Fax

Practice location:
  • Phone: 832-869-4818
  • Fax: 832-241-2902
Mailing address:
  • Phone: 806-381-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39242
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberQ1983
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: