MEDICARE: LEONEL DE LA GARZA

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	183700000X	Pharmacy Technician	109443	TX

General Provider Information

NPI Number	:	1508457763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONEL DE LA GARZA

Provider Business Mailing Address
First Line	:	1906 S LINCOLN AVE
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589
Country	:	US
Telephone Number	:	956-784-1121
Fax Number	:	956-258-5048

Provider Business Practice Location Address
First Line	:	1906 S LINCOLN AVE
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589
Country	:	US
Telephone Number	:	956-784-1121
Fax Number	:	956-258-5048

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

Provider Enumeration Date	:	01/31/2021
Last Update Date	:	01/31/2021

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