Provider Demographics
NPI:1770299463
Name:GARZA, IDA ARACELI
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:ARACELI
Last Name:GARZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4127 CAPITOL LN
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-5133
Mailing Address - Country:US
Mailing Address - Phone:956-251-1349
Mailing Address - Fax:
Practice Address - Street 1:4127 CAPITOL LN
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-5133
Practice Address - Country:US
Practice Address - Phone:956-251-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX838698163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX838698OtherTEXAS BOARD OF NURSING