Provider Demographics
NPI:1376847954
Name:GARZA, NADIA MARIE
Entity Type:Individual
Prefix:MS
First Name:NADIA
Middle Name:MARIE
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 1:501 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-2739
Mailing Address - Country:US
Mailing Address - Phone:979-618-0743
Mailing Address - Fax:
Practice Address - Street 1:501 WILLOW LN
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-2739
Practice Address - Country:US
Practice Address - Phone:979-618-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17046090172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27-4300674OtherEMPLOYER IDENTIFICATION NUMBER