Provider Demographics
NPI:1487074563
Name:GARZA, JAIME
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
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:PO BOX 731
Mailing Address - Street 2:
Mailing Address - City:LA VILLA
Mailing Address - State:TX
Mailing Address - Zip Code:78562-0731
Mailing Address - Country:US
Mailing Address - Phone:956-292-0444
Mailing Address - Fax:956-292-0446
Practice Address - Street 1:215 E CANO ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-4509
Practice Address - Country:US
Practice Address - Phone:956-292-0444
Practice Address - Fax:956-292-0446
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139256261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139256OtherTEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES ADULT DAY CARE LICENSE