Provider Demographics
NPI:1538761796
Name:GARZA, DIANA LINDA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LINDA
Last Name: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 1:629 W LEE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-4331
Mailing Address - Country:US
Mailing Address - Phone:361-522-0338
Mailing Address - Fax:
Practice Address - Street 1:1133 E GENERAL CAVAZOS BLVD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7142
Practice Address - Country:US
Practice Address - Phone:361-595-5429
Practice Address - Fax:361-595-7609
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist