Provider Demographics
NPI:1891715769
Name:GARZA, JUAN LUIS (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:LUIS
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 1:1933 NE LOOP 410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5320
Mailing Address - Country:US
Mailing Address - Phone:210-804-6001
Mailing Address - Fax:
Practice Address - Street 1:225 E SONTERRA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3996
Practice Address - Country:US
Practice Address - Phone:210-403-2926
Practice Address - Fax:210-403-2184
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9470207R00000X
CA98388207RC0000X
TX98388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099159801Medicaid
TX85V350OtherBCBS
TXA37613Medicare UPIN
TX110078955Medicare PIN
TX85V350Medicare PIN