Provider Demographics
NPI:1013381995
Name:GARZA, BERTHA
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:
Last Name:GARZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:ALICIA
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 W COURT ST
Mailing Address - Street 2:P.O. BOX 1452
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4153
Mailing Address - Country:US
Mailing Address - Phone:509-543-1980
Mailing Address - Fax:509-542-0467
Practice Address - Street 1:715 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4153
Practice Address - Country:US
Practice Address - Phone:509-543-1980
Practice Address - Fax:509-542-0467
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator