Basic Information
| Provider Information | |||||||||
| NPI: | 1205060233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARZA | ||||||||
| FirstName: | AZAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2535 SW MILITARY DR STE 104 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782241041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109274965 | ||||||||
| FaxNumber: | 2109274997 | ||||||||
| Practice Location | |||||||||
| Address1: | 2535 SW MILITARY DR STE 104 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782241041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109274965 | ||||||||
| FaxNumber: | 2109274997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2009 | ||||||||
| LastUpdateDate: | 05/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 80229 | TX | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2037699-01 | 05 | TX | MEDICAID |