Provider Demographics
NPI:1396231320
Name:GARZA MEDICAL GROUP @ SOUTH ALAMO
Entity Type:Organization
Organization Name:GARZA MEDICAL GROUP @ SOUTH ALAMO
Other - Org Name:GARZA MEDICAL GROUP -SOUTH ALAMO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCANEGRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-256-1539
Mailing Address - Street 1:5414 FREDERICKSBURG RD STE 265
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3641
Mailing Address - Country:US
Mailing Address - Phone:210-256-1539
Mailing Address - Fax:210-598-0206
Practice Address - Street 1:5414 FREDERICKSBURG RD STE 265
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3641
Practice Address - Country:US
Practice Address - Phone:210-256-1539
Practice Address - Fax:210-549-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1972500684OtherPPO, HMO AND MARKET-PLACE
TX1396231320Medicaid
TX1972500684Medicaid
TX1396231320OtherPPO, HMO AND MARKET PLACE