Provider Demographics
NPI:1528541554
Name:GARZA, MARLENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:
Last Name:GARZA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7381 LA TIJERA BLVD UNIT 45312
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-7017
Mailing Address - Country:US
Mailing Address - Phone:310-948-3182
Mailing Address - Fax:
Practice Address - Street 1:7381 LA TIJERA BLVD UNIT 45312
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-7017
Practice Address - Country:US
Practice Address - Phone:310-948-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31888103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist