=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760504906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA CANTERA PEDIATRICS, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 08/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21195 IH 10 W SUITE 2101
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78257-1674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-687-1144
-----------------------------------------------------
Fax | 210-687-1146
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21195 IH 10 W SUITE 2101
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78257-1674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-687-1144
-----------------------------------------------------
Fax | 210-687-1146
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ARMANDO DAVID GARZA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 210-632-4992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | M1106
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------