Healthcare Provider Details

I. General information

NPI: 1679059174
Provider Name (Legal Business Name): ALEJANDRO GABRIEL GARZA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 TOURNAMENT TRAIL DR
LAREDO TX
78041-6564
US

IV. Provider business mailing address

3210 JAIME ZAPATA MEMORIAL HWY STE A5
LAREDO TX
78043-5010
US

V. Phone/Fax

Practice location:
  • Phone: 956-727-3422
  • Fax:
Mailing address:
  • Phone: 956-712-9111
  • Fax: 956-712-8421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2091532
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: