Provider Demographics
NPI:1881721488
Name:GARZA, FERNANDO JOSE (RSA)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:JOSE
Last Name:GARZA
Suffix:
Gender:M
Credentials:RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7146 183RD ST # 111
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3933
Mailing Address - Country:US
Mailing Address - Phone:630-750-0792
Mailing Address - Fax:
Practice Address - Street 1:228 W LINCOLN HIGHWAY 30 # 127
Practice Address - Street 2:#127
Practice Address - City:SCHEREVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375
Practice Address - Country:US
Practice Address - Phone:630-291-8614
Practice Address - Fax:630-216-1105
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000017246ZC0007X, 246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL238.000017OtherREGISTERED SURGICAL ASST.