Healthcare Provider Details

I. General information

NPI: 1548558794
Provider Name (Legal Business Name): VANGUARDIA ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 N CAGE BLVD STE N
PHARR TX
78577-1812
US

IV. Provider business mailing address

5510 N CAGE BLVD STE N
PHARR TX
78577-1812
US

V. Phone/Fax

Practice location:
  • Phone: 956-782-9803
  • Fax: 956-782-9009
Mailing address:
  • Phone: 956-782-9803
  • Fax: 956-782-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number101863
License Number StateTX

VIII. Authorized Official

Name: JOEL GARZA
Title or Position: CEO / OWNER / MEMBER
Credential:
Phone: 956-217-2640