Provider Demographics
NPI:1215558309
Name:GARZA, LARIZA
Entity Type:Individual
Prefix:
First Name:LARIZA
Middle Name:
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 1:6452 KINGSLEY EDGE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78252-1831
Mailing Address - Country:US
Mailing Address - Phone:210-902-6524
Mailing Address - Fax:210-783-9295
Practice Address - Street 1:6452 KINGSLEY EDGE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78252-1831
Practice Address - Country:US
Practice Address - Phone:210-902-6524
Practice Address - Fax:210-783-9295
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
TX0199883747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1215558309Medicaid
TX412379601Medicaid