=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174642698
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUAN JOEL GARZA, MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 02/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2310 N. ED CAREY DRIVE SUITE 1A
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-428-5522
-----------------------------------------------------
Fax | 956-926-4350
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 E. RIDGE ROAD SUITE 100
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-630-5522
-----------------------------------------------------
Fax | 956-926-4350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIAL COORDINATOR
-----------------------------------------------------
Name | MISS NORMALINDA HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-430-3413
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | K7157
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------