Provider Demographics
NPI:1578329082
Name:DE LA GARZA, RODOLFO (RUDY)
Entity Type:Individual
Prefix:
First Name:RODOLFO (RUDY)
Middle Name:
Last Name:DE LA GARZA
Suffix:
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 1:2141 EL INDIO HWY STE A2141
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5455
Mailing Address - Country:US
Mailing Address - Phone:830-757-0000
Mailing Address - Fax:830-757-0008
Practice Address - Street 1:2141 EL INDIO HWY STE A2141
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5455
Practice Address - Country:US
Practice Address - Phone:830-757-0000
Practice Address - Fax:830-757-0008
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician