Provider Demographics
NPI:1598967861
Name:GUSTAVO GARCIA & SYLVIA GARCIA
Entity Type:Organization
Organization Name:GUSTAVO GARCIA & SYLVIA GARCIA
Other - Org Name:SOUTH TEXAS PROVIDER SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:956-969-2472
Mailing Address - Street 1:811 E PIKE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4935
Mailing Address - Country:US
Mailing Address - Phone:956-969-2472
Mailing Address - Fax:956-447-2207
Practice Address - Street 1:811 E PIKE BLVD
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4935
Practice Address - Country:US
Practice Address - Phone:956-969-2472
Practice Address - Fax:956-447-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006547376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001000753Medicaid
TX001012639Medicaid
TX000117500Medicaid