Provider Demographics
NPI:1669449971
Name:GARZA, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:GARZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 MOONLIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5000
Mailing Address - Country:US
Mailing Address - Phone:210-558-8878
Mailing Address - Fax:210-558-9389
Practice Address - Street 1:4318 MOONLIGHT WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5000
Practice Address - Country:US
Practice Address - Phone:210-558-8878
Practice Address - Fax:210-558-9389
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H95557Medicare UPIN
TX8D5032Medicare ID - Type Unspecified