Provider Demographics
NPI:1083033450
Name:GARZA, RUDY (REPT)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:
Last Name:GARZA
Suffix:
Gender:M
Credentials:REPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 JAY ELL DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1837
Mailing Address - Country:US
Mailing Address - Phone:888-344-2947
Mailing Address - Fax:888-694-2947
Practice Address - Street 1:1819 JAY ELL DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1837
Practice Address - Country:US
Practice Address - Phone:888-344-2947
Practice Address - Fax:888-694-2947
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191423164X00000X
TX1490246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX337550Medicare PIN