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General NPI Number Information
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NPI Number | 1316410426
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Entity Type | Individual
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Provider Name | MYRA LEIGH DE LA GARZA NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 3804 S JACKSON RD STE 3
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City | EDINBURG
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State | TX
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Zip | 78539-6683
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Country | US
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Telephone | 956-296-3041
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Fax | 956-296-3040
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Provider Business Mailing Address
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Address Line | 1612 E 30TH ST
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City | MISSION
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State | TX
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Zip | 78574-1788
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Country | US
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Telephone | 956-248-6606
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP139673
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License Number State | TX
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