Provider Demographics
NPI:1629359583
Name:GARZA, JASON ASHELY (LPTA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ASHELY
Last Name:GARZA
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-2546
Mailing Address - Country:US
Mailing Address - Phone:979-533-2522
Mailing Address - Fax:
Practice Address - Street 1:2317 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-2546
Practice Address - Country:US
Practice Address - Phone:979-533-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2080310172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker