Provider Demographics
NPI:1629476775
Name:AUSTIN, ELISE GARZA (MS)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:GARZA
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E 3900 S
Mailing Address - Street 2:CANCER GENETICS PROGRAM
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-743-6509
Mailing Address - Fax:801-951-4919
Practice Address - Street 1:1140 E 3900 S
Practice Address - Street 2:ST. MARK'S WOMEN'S DIAGNOSTIC CENTER
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-743-6509
Practice Address - Fax:801-951-4919
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9187325-3601170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS