Basic Information
| Provider Information | |||||||||
| NPI: | 1902343197 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARZA | ||||||||
| FirstName: | HUMBERTO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5358 | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785025358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563625673 | ||||||||
| FaxNumber: | 9563622132 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 RAPHAEL DR | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785391407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563625673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 133V00000X | DT83619 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 368247801 | 05 | TX | MEDICAID |