Healthcare Provider Details

I. General information

NPI: 1184407371
Provider Name (Legal Business Name): MARINA DE LA GARZA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 FENWICK DR
WINDCREST TX
78239-2532
US

IV. Provider business mailing address

513 FENWICK DR
WINDCREST TX
78239-2532
US

V. Phone/Fax

Practice location:
  • Phone: 210-549-7453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15681
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: