Healthcare Provider Details

I. General information

NPI: 1902887094
Provider Name (Legal Business Name): ARIANA M DE LA GARZA PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 STARR ST STE 1
MERCEDES TX
78570-2736
US

IV. Provider business mailing address

PO BOX 2293
MISSION TX
78573-0037
US

V. Phone/Fax

Practice location:
  • Phone: 956-514-1643
  • Fax: 956-514-2564
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04495
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA04495
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: