Provider Demographics
NPI:1275513749
Name:GARZA, REBECCA (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:GARZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CALLE DEL NORTE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-9133
Mailing Address - Country:US
Mailing Address - Phone:956-794-8770
Mailing Address - Fax:956-794-8772
Practice Address - Street 1:121 CALLE DEL NORTE
Practice Address - Street 2:SUITE 104
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-9133
Practice Address - Country:US
Practice Address - Phone:956-794-8770
Practice Address - Fax:956-794-8772
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXG2750208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134812009Medicaid
TX134812009Medicaid