Provider Demographics
NPI:1538294376
Name:DELAGARZA, POLYANNA (OD)
Entity Type:Individual
Prefix:
First Name:POLYANNA
Middle Name:
Last Name:DELAGARZA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17282 SH 249 AT FM 1960
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1106
Mailing Address - Country:US
Mailing Address - Phone:281-955-9999
Mailing Address - Fax:281-955-9931
Practice Address - Street 1:17282 SH 249 AT FM 1960
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1106
Practice Address - Country:US
Practice Address - Phone:281-955-9999
Practice Address - Fax:281-955-9931
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6790TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V08088Medicare UPIN
TX8G3378Medicare ID - Type Unspecified