MEDICARE: JOANNA GARZA MARTINEZ PA C

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	363A00000X	Physician Assistant	PA20020032	NM
2	363A00000X	Physician Assistant	PA02576	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001020	OTHER	NM	BC BS OF NM

General Provider Information

NPI Number	:	1427001510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA GARZA MARTINEZ PA C

Provider Business Mailing Address
First Line	:	13407 EMERALD SKIES WAY
Second Line	:
City	:	HORIZON CITY
State	:	TX
Zip	:	79928-6462
Country	:	US
Telephone Number	:	915-252-9910
Fax Number	:

Provider Business Practice Location Address
First Line	:	13407 EMERALD SKIES WAY
Second Line	:
City	:	HORIZON CITY
State	:	TX
Zip	:	79928-6462
Country	:	US
Telephone Number	:	915-252-9910
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	09/27/2013

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