Provider Demographics
NPI:1750701249
Name:GARZON, DESIREE OLGA (DPM)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:OLGA
Last Name:GARZON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MS
Other - First Name:DESIREE
Other - Middle Name:OLGA
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1325 S CONGRESS AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5802
Mailing Address - Country:US
Mailing Address - Phone:561-369-3300
Mailing Address - Fax:561-734-2811
Practice Address - Street 1:1325 S CONGRESS AVE STE 108
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5802
Practice Address - Country:US
Practice Address - Phone:561-369-3300
Practice Address - Fax:561-734-2811
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3608213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013076100Medicaid