Provider Demographics
NPI:1669437869
Name:DE LA GARZA, MIGUEL ADAN (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ADAN
Last Name:DE LA 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 1:4807 US HIGHWAY 19 STE 102
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4260
Mailing Address - Country:US
Mailing Address - Phone:727-846-7618
Mailing Address - Fax:727-849-7090
Practice Address - Street 1:4807 US HIGHWAY 19 STE 102
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4260
Practice Address - Country:US
Practice Address - Phone:727-846-7618
Practice Address - Fax:727-849-7090
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96073207L00000X, 207LP2900X, 208VP0014X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI60367Medicare UPIN
U8022ZMedicare PIN