Healthcare Provider Details

I. General information

NPI: 1770156408
Provider Name (Legal Business Name): ITZEL ARIADNA DE LA GARZA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8507 CULEBRA RD STE 101
SAN ANTONIO TX
78251-4810
US

IV. Provider business mailing address

14015 UNIVERSITY PASS APT 3407
SAN ANTONIO TX
78249-1136
US

V. Phone/Fax

Practice location:
  • Phone: 833-646-3222
  • Fax:
Mailing address:
  • Phone: 210-986-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number9442
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: