Provider Demographics
NPI:1225584113
Name:ADULT HEALTH CLINIC
Entity Type:Organization
Organization Name:ADULT HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:956-230-8242
Mailing Address - Street 1:1519 E BUSTAMANTE ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5305
Mailing Address - Country:US
Mailing Address - Phone:956-230-8242
Mailing Address - Fax:
Practice Address - Street 1:1519 E BUSTAMANTE ST STE B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5305
Practice Address - Country:US
Practice Address - Phone:956-230-8242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1174883177OtherINDIVIDUAL NPI