Healthcare Provider Details

I. General information

NPI: 1831501576
Provider Name (Legal Business Name): MRS. MARY JO DE LA GARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY JO ALVAREZ

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47825 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

47825 OASIS ST
INDIO CA
92201-6950
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8455
  • Fax: 760-863-8587
Mailing address:
  • Phone: 760-863-8521
  • Fax: 760-347-8507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: