Healthcare Provider Details

I. General information

NPI: 1881279131
Provider Name (Legal Business Name): MATTHEW ALEXANDER GARZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 FRESNO ST STE 101
FRESNO CA
93706-3641
US

IV. Provider business mailing address

302 FRESNO ST STE 101
FRESNO CA
93706-3641
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-5700
  • Fax: 559-457-5790
Mailing address:
  • Phone: 559-457-5700
  • Fax: 559-457-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number125002
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number146655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: