Healthcare Provider Details

I. General information

NPI: 1235198946
Provider Name (Legal Business Name): TERESA MARIE GARZA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CO NAVAL HOSPITAL BOX 555191
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

116 SURSEE CT
NEW BERN NC
28562-7071
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-8578
  • Fax:
Mailing address:
  • Phone: 252-288-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number606910
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number214181
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: