Provider Demographics
NPI:1013214899
Name:GARZA, LISA MARIE (R,T(R)(MR))
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:GARZA
Suffix:
Gender:F
Credentials:R,T(R)(MR)
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT(R)
Mailing Address - Street 1:3206 FENN ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-3500
Mailing Address - Country:US
Mailing Address - Phone:432-816-6053
Mailing Address - Fax:
Practice Address - Street 1:300 W VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5566
Practice Address - Country:US
Practice Address - Phone:432-263-7361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3510742471C3402X, 2471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging