Provider Demographics
NPI:1154924751
Name:RENDON-GARZA, MARIANA
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:RENDON-GARZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CONDOR AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2719
Mailing Address - Country:US
Mailing Address - Phone:956-369-3500
Mailing Address - Fax:
Practice Address - Street 1:100 E FM 495
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3710
Practice Address - Country:US
Practice Address - Phone:956-283-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist