Provider Demographics
NPI:1821485509
Name:GARZA, JESUS E (PA)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:E
Last Name:GARZA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2922 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-2141
Mailing Address - Country:US
Mailing Address - Phone:361-887-6601
Mailing Address - Fax:361-887-8225
Practice Address - Street 1:2922 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-2141
Practice Address - Country:US
Practice Address - Phone:361-887-6601
Practice Address - Fax:361-887-8225
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX411173YLPSOtherWELLMED PTAN
TX348975901Medicaid