Provider Demographics
NPI:1518541499
Name:GARZON, ALEXIS ANDRES (LVN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANDRES
Last Name:GARZON
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6483 N CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-3059
Mailing Address - Country:US
Mailing Address - Phone:562-415-7119
Mailing Address - Fax:
Practice Address - Street 1:6483 N CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3059
Practice Address - Country:US
Practice Address - Phone:562-415-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA713710164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse