Provider Demographics
NPI:1487206298
Name:GARZA, JESUS SOCORRO JR
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:SOCORRO
Last Name:GARZA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 E HONOLULU AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0646
Mailing Address - Country:US
Mailing Address - Phone:956-683-7195
Mailing Address - Fax:
Practice Address - Street 1:1812 E HONOLULU AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-0646
Practice Address - Country:US
Practice Address - Phone:956-683-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications