Individual provider Active NPI

Mayra Guadalupe Garza, PA-C

  • Physician Assistant
  • Laredo, TX
National Provider Identifier
1669718110
Registry record updated Oct 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA07953 Issued in TX
Practice address
1515 Pappas St
Laredo, TX 78041-1705
Phone
(956) 523-3683
Fax
(956) 718-6294
NPI assigned
Jan 2, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA07953 TX Primary

Addresses

Primary practice location

1515 Pappas St
Laredo, TX 78041-1705

Mailing address

1515 Pappas St
Laredo, TX 78041-1705
Phone (956) 523-3683

Other identifiers 1

IdentifierTypeStateIssuer
PA07953OtherTXLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130826000712 TX Practitioner - Physician Assistant 0648413500 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gateway Community Health Center, Inc CurrentSince Jul 29, 2013 Accepting new patients
Gateway Community Health Center, Inc CurrentSince Jul 29, 2013 Accepting new patients
Gateway Community Health Center, Inc. Past Accepting new patients

Locations

1702 Lafayette St
Laredo, TX 78041
Phone (956) 625-3344

1515 Pappas St
Laredo, TX 78041
Phone (956) 523-3642

210 Rathmell
Zapata, TX 78076
Phone (956) 765-4367

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383091200000",
    "number": "1669718110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 PAPPAS ST",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780411705",
            "telephone_number": "956-523-3683",
            "fax_number": "956-718-6294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 PAPPAS ST",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780411705",
            "telephone_number": "956-523-3683",
            "fax_number": "956-718-6294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARZA",
        "first_name": "MAYRA",
        "middle_name": "GUADALUPE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-02",
        "last_updated": "2013-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA07953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA07953",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laredo, TX

Sources for this page

Verify at the official NPI Registry.