Provider Demographics
NPI:1487621322
Name:GARZA, DIANE S (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:S
Last Name:GARZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 N MO PAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2415
Mailing Address - Country:US
Mailing Address - Phone:512-334-2504
Mailing Address - Fax:512-334-2594
Practice Address - Street 1:5701 W SLAUGHTER LN BLDG C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-6528
Practice Address - Country:US
Practice Address - Phone:512-334-2504
Practice Address - Fax:512-334-2594
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2022208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119209802Medicaid
TX88G231Medicare PIN
TX8L16049Medicare PIN
TX370007429Medicare PIN
TX119209802Medicaid