Provider Demographics
NPI:1376532838
Name:AYDA GARZA -MONTALVO
Entity Type:Organization
Organization Name:AYDA GARZA -MONTALVO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA-MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-383-4988
Mailing Address - Street 1:4302 S SUGAR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7073
Mailing Address - Country:US
Mailing Address - Phone:956-383-4988
Mailing Address - Fax:956-383-5096
Practice Address - Street 1:4302 S SUGAR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7073
Practice Address - Country:US
Practice Address - Phone:956-383-4988
Practice Address - Fax:956-383-5096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2024173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG9749Medicare UPIN
TX80H719Medicare ID - Type Unspecified