Provider Demographics
NPI:1629451364
Name:GARZA, KEANDRA
Entity Type:Individual
Prefix:
First Name:KEANDRA
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 1:709 JADE ST APT B
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-5626
Mailing Address - Country:US
Mailing Address - Phone:956-800-9398
Mailing Address - Fax:
Practice Address - Street 1:709 JADE ST APT B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-5626
Practice Address - Country:US
Practice Address - Phone:956-800-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program