Provider Demographics
NPI:1699342477
Name:DE LA GARZA HERNANDEZ, GILBERTO
Entity type:Individual
Prefix:
First Name:GILBERTO
Middle Name:
Last Name:DE LA GARZA HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 W. POLK AVE STE. 110
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577
Mailing Address - Country:US
Mailing Address - Phone:956-510-8058
Mailing Address - Fax:956-510-8098
Practice Address - Street 1:1431 W. POLK AVE STE. 110
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577
Practice Address - Country:US
Practice Address - Phone:956-510-8058
Practice Address - Fax:956-510-8098
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health