Provider Demographics
NPI:1396441069
Name:GARZA, GERARDO ADALBERTO
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:ADALBERTO
Last Name:GARZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BAFFIN BAY
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1940
Mailing Address - Country:US
Mailing Address - Phone:832-628-9554
Mailing Address - Fax:
Practice Address - Street 1:1700 E SAUNDERS ST STE A300
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5474
Practice Address - Country:US
Practice Address - Phone:956-728-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily