Healthcare Provider Details

I. General information

NPI: 1861323693
Provider Name (Legal Business Name): JEANIE L GARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47950 DUNE PALMS RD
LA QUINTA CA
92253-4000
US

IV. Provider business mailing address

49286 MONTPELIER DR
INDIO CA
92201-8873
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-4200
  • Fax:
Mailing address:
  • Phone: 760-636-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: