Provider Demographics
NPI:1760504906
Name:LA CANTERA PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:LA CANTERA PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-632-4992
Mailing Address - Street 1:21195 IH 10 W
Mailing Address - Street 2:SUITE 2101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1674
Mailing Address - Country:US
Mailing Address - Phone:210-687-1144
Mailing Address - Fax:210-687-1146
Practice Address - Street 1:21195 IH 10 W
Practice Address - Street 2:SUITE 2101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1674
Practice Address - Country:US
Practice Address - Phone:210-687-1144
Practice Address - Fax:210-687-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1106208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180342104Medicaid
TX185740103Medicaid
TX185740102Medicaid