Healthcare Provider Details

I. General information

NPI: 1235360355
Provider Name (Legal Business Name): JOSE ISAAC GARZA LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HURLBUT ST
PASADENA CA
91105-4025
US

IV. Provider business mailing address

315 E BROADWAY APT 214
SAN GABRIEL CA
91776-6826
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-4221
  • Fax: 626-441-6479
Mailing address:
  • Phone: 323-691-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN 199993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: