Healthcare Provider Details

I. General information

NPI: 1528541554
Provider Name (Legal Business Name): MARLENE GARZA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7381 LA TIJERA BLVD UNIT 45312
LOS ANGELES CA
90045-7017
US

IV. Provider business mailing address

7381 LA TIJERA BLVD UNIT 45312
LOS ANGELES CA
90045-7017
US

V. Phone/Fax

Practice location:
  • Phone: 310-948-3182
  • Fax:
Mailing address:
  • Phone: 310-948-3182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number31888
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number31888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: