Provider Demographics
NPI:1568943652
Name:GARZA, MAX JOSEPH I (SLP ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:MAX
Middle Name:JOSEPH
Last Name:GARZA
Suffix:I
Gender:M
Credentials:SLP ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5496
Mailing Address - Country:US
Mailing Address - Phone:956-463-2899
Mailing Address - Fax:
Practice Address - Street 1:1126 W MONTECRISTO RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541
Practice Address - Country:US
Practice Address - Phone:956-683-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36264Medicaid