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General NPI Number Information
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NPI Number | 1225017122
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Entity Type | Individual
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Provider Name | CARLOS DE LA GARZA M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 2412 WILKINS DR
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City | SANFORD
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State | NC
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Zip | 27330-7268
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Country | US
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Telephone | 919-776-6000
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Fax | 919-776-0130
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Provider Business Mailing Address
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Address Line | 330 SEVEN SPRINGS WAY ATTN: PROVIDER ENROLLMENT
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City | BRENTWOOD
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State | TN
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Zip | 37027-5098
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Country | US
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Telephone | 615-920-7000
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Fax | 615-920-8775
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 28019
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 8428019
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License Number State | NC
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