MEDICARE: MRS. CHRISTINA DELAGARZA GUZMAN MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	1112902	TX

General Provider Information

NPI Number	:	1043442577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA DELAGARZA GUZMAN MPT

Provider Business Mailing Address
First Line	:	9605 BIG GERONIMO ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-1705
Country	:	US
Telephone Number	:	210-663-5230
Fax Number	:	210-543-7205

Provider Business Practice Location Address
First Line	:	9605 BIG GERONIMO ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-1705
Country	:	US
Telephone Number	:	210-663-5230
Fax Number	:	210-543-7205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	08/17/2009

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