Basic Information
Provider Information
NPI: 1962972745
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARZA
FirstName: JAMES
MiddleName: ANTHONY
NamePrefix: MR.
NameSuffix:  
Credential: SLPA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 305 NE LOOP 820 BUSINESS TOWER 1
Address2: BUSINESS TOWER 1 SUITE 200
City: HURST
State: TX
PostalCode: 76053
CountryCode: US
TelephoneNumber: 8172928787
FaxNumber:  
Practice Location
Address1: 915 W EXCHANGE PKWY STE 100
Address2:  
City: ALLEN
State: TX
PostalCode: 750137018
CountryCode: US
TelephoneNumber: 2145471571
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/05/2018
LastUpdateDate: 12/05/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2355S0801X40874TXY Speech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant

No ID Information.


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