Provider Demographics
NPI:1669615944
Name:GARCIA MAYORGA, JESUS GUILLERMO (MD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:GUILLERMO
Last Name:GARCIA MAYORGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JESUS
Other - Middle Name:GUILLERMO
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9601 SPUR 591
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79107-9606
Mailing Address - Country:US
Mailing Address - Phone:806-381-7080
Mailing Address - Fax:
Practice Address - Street 1:7877 WILLOW CHASE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5934
Practice Address - Country:US
Practice Address - Phone:832-869-4818
Practice Address - Fax:832-241-2902
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA392422084P0800X
TXQ19832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3704983-01Medicaid