Provider Demographics
NPI:1174562391
Name:GARZA, MARIO (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name: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 1:13114 FM 1960 RD W
Mailing Address - Street 2:114
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4290
Mailing Address - Country:US
Mailing Address - Phone:281-469-2838
Mailing Address - Fax:281-469-9314
Practice Address - Street 1:13114 FM 1960 RD W
Practice Address - Street 2:114
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4290
Practice Address - Country:US
Practice Address - Phone:281-469-2838
Practice Address - Fax:281-469-9314
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9348208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E58482Medicare UPIN