Provider Demographics
NPI:1073708699
Name:GARZA, BRENDA SMITH (RN, RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:SMITH
Last Name:GARZA
Suffix:
Gender:F
Credentials:RN, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 SUN N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2130
Mailing Address - Country:US
Mailing Address - Phone:863-402-0177
Mailing Address - Fax:863-402-0220
Practice Address - Street 1:4023 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2130
Practice Address - Country:US
Practice Address - Phone:863-402-0177
Practice Address - Fax:863-402-0220
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584843133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered