Provider Demographics
NPI:1326640152
Name:DE LA GARZA, TERESA M
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:DE LA GARZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:M
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2054 S 77TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-1111
Mailing Address - Country:US
Mailing Address - Phone:414-550-4696
Mailing Address - Fax:414-800-1499
Practice Address - Street 1:2054 S 77TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-1111
Practice Address - Country:US
Practice Address - Phone:414-550-4696
Practice Address - Fax:414-800-1499
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator