=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528608247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISAIAS GARZA JR PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2020
-----------------------------------------------------
Last Update Date | 01/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1516 DEMARET CT
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78045-7542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-334-0477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1516 DEMARET CT
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78045-7542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-334-0477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ISAIAS GARZA JR.
-----------------------------------------------------
Credential | MEDICAL DOCTOR
-----------------------------------------------------
Telephone | 956-334-0477
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0000X
-----------------------------------------------------
Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------