Provider Demographics
NPI:1265590715
Name:GARZA, EVANGELINA D (OTR)
Entity type:Individual
Prefix:MRS
First Name:EVANGELINA
Middle Name:D
Last Name:GARZA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:EVANGELINA
Other - Middle Name:
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:1900 S JACKSON RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1589
Mailing Address - Country:US
Mailing Address - Phone:956-630-4400
Mailing Address - Fax:956-630-4447
Practice Address - Street 1:1900 S JACKSON RD STE 3
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1589
Practice Address - Country:US
Practice Address - Phone:956-630-4400
Practice Address - Fax:956-630-4447
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111166225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143404501Medicaid
TX742965954OtherFACILITY TAX ID NO.
TX454597Medicare ID - Type UnspecifiedFACILITY MDCR ID NO.