Healthcare Provider Details

I. General information

NPI: 1205060233
Provider Name (Legal Business Name): MR. AZAEL GARZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 SW MILITARY DR STE 104
SAN ANTONIO TX
78224-1041
US

IV. Provider business mailing address

2535 SW MILITARY DR STE 104
SAN ANTONIO TX
78224-1041
US

V. Phone/Fax

Practice location:
  • Phone: 210-927-4965
  • Fax: 210-927-4997
Mailing address:
  • Phone: 210-927-4965
  • Fax: 210-927-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80229
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: