Healthcare Provider Details

I. General information

NPI: 1982349213
Provider Name (Legal Business Name): IZAMAR DE LA GARZA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E EUCLID AVE
SAN ANTONIO TX
78212-4414
US

IV. Provider business mailing address

PO BOX 35629
DALLAS TX
75235-0629
US

V. Phone/Fax

Practice location:
  • Phone: 210-271-0606
  • Fax: 210-271-3208
Mailing address:
  • Phone: 214-424-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1076190
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: