Provider Demographics
NPI:1659575546
Name:MARIA LYDIA GARZA DBA EL PARQUE EL PASO
Entity Type:Organization
Organization Name:MARIA LYDIA GARZA DBA EL PARQUE EL PASO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-487-2097
Mailing Address - Street 1:801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-3120
Mailing Address - Country:US
Mailing Address - Phone:956-487-2097
Mailing Address - Fax:956-488-0383
Practice Address - Street 1:6501 BOEING DR STE B3
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1048
Practice Address - Country:US
Practice Address - Phone:915-781-2233
Practice Address - Fax:915-781-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118407261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care