Provider Demographics
NPI:1790012789
Name:GARZA, SIERRA
Entity Type:Individual
Prefix:
First Name:SIERRA
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:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82411-0152
Mailing Address - Country:US
Mailing Address - Phone:307-272-6656
Mailing Address - Fax:
Practice Address - Street 1:710 LANE 39
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WY
Practice Address - Zip Code:82411-9739
Practice Address - Country:US
Practice Address - Phone:307-272-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator