Provider Demographics
NPI:1679059174
Name:GARZA, ALEJANDRO GABRIEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:GABRIEL
Last Name:GARZA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 JAIME ZAPATA MEMORIAL HWY STE A5
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-5010
Mailing Address - Country:US
Mailing Address - Phone:956-712-9111
Mailing Address - Fax:956-712-8421
Practice Address - Street 1:1701 TOURNAMENT TRAIL DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6564
Practice Address - Country:US
Practice Address - Phone:956-727-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2091532314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility