Provider Demographics
NPI:1316410426
Name:DE LA GARZA, MYRA LEIGH (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:LEIGH
Last Name:DE LA GARZA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-1788
Mailing Address - Country:US
Mailing Address - Phone:956-248-6606
Mailing Address - Fax:
Practice Address - Street 1:3804 S JACKSON RD STE 3
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6683
Practice Address - Country:US
Practice Address - Phone:956-296-3041
Practice Address - Fax:956-296-3040
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX395081801Medicaid
TXH08KV811OtherBCBS