Provider Demographics
NPI:1982168720
Name:MADRIAGA, ALEXANDER GARCIA
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GARCIA
Last Name:MADRIAGA
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 1:1903 GUSTAVUS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-2336
Mailing Address - Country:US
Mailing Address - Phone:956-334-8283
Mailing Address - Fax:
Practice Address - Street 1:REGENT CARE CENTER
Practice Address - Street 2:7001 MCPHERSON AVENUE
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-723-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2051377225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16471757OtherDRIVERS LICENSE