Provider Demographics
NPI:1043375124
Name:DELAGARZA, SHAWN C (CEO,COO)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:C
Last Name:DELAGARZA
Suffix:
Gender:M
Credentials:CEO,COO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N MCCOLL RD STE B
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9358
Mailing Address - Country:US
Mailing Address - Phone:956-630-3400
Mailing Address - Fax:956-630-2910
Practice Address - Street 1:320 N MCCOLL RD STE B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-9358
Practice Address - Country:US
Practice Address - Phone:956-630-3400
Practice Address - Fax:956-630-2910
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTX035Medicare PIN