Provider Demographics
NPI:1598122780
Name:GARZA, ADRIAN MARCELLO (CST/SA-C)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:MARCELLO
Last Name:GARZA
Suffix:
Gender:M
Credentials:CST/SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 PECAN DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7426
Mailing Address - Country:US
Mailing Address - Phone:469-955-8156
Mailing Address - Fax:
Practice Address - Street 1:2001 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 655
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2256
Practice Address - Country:US
Practice Address - Phone:972-457-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX820982246ZS0410X
TX16-376246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist