Provider Demographics
NPI:1831497486
Name:GARZA, GRACE (RN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:GARZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4137
Mailing Address - Country:US
Mailing Address - Phone:575-234-3312
Mailing Address - Fax:575-234-3561
Practice Address - Street 1:1600 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4137
Practice Address - Country:US
Practice Address - Phone:575-234-3312
Practice Address - Fax:575-234-3561
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR53743163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse