MEDICARE: ITZEL ARIADNA DE LA GARZA MA

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	103K00000X	Behavior Analyst	9442	TX

General Provider Information

NPI Number	:	1770156408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ITZEL ARIADNA DE LA GARZA MA

Provider Business Mailing Address
First Line	:	14015 UNIVERSITY PASS APT 3407
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1136
Country	:	US
Telephone Number	:	210-986-8914
Fax Number	:

Provider Business Practice Location Address
First Line	:	8507 CULEBRA RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4810
Country	:	US
Telephone Number	:	833-646-3222
Fax Number	:

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

Provider Enumeration Date	:	07/20/2021
Last Update Date	:	12/03/2025

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