Provider Demographics
NPI:1942436126
Name:JAVIER ENRIQUE DE LA GARZA, M.D., P.A.
Entity Type:Organization
Organization Name:JAVIER ENRIQUE DE LA GARZA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:DE LA GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-350-4788
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:OLMITO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-0279
Mailing Address - Country:US
Mailing Address - Phone:956-350-4788
Mailing Address - Fax:956-350-9547
Practice Address - Street 1:100B E ALTON GLOOR BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3376
Practice Address - Country:US
Practice Address - Phone:956-350-4788
Practice Address - Fax:956-350-9547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3279261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A4533Medicare PIN