Healthcare Provider Details

I. General information

NPI: 1457601676
Provider Name (Legal Business Name): HEATHER LEA GARZA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CAPITOLA RD
SANTA CRUZ CA
95062-2912
US

IV. Provider business mailing address

125 WATER ST STE B
SANTA CRUZ CA
95060-2792
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-3500
  • Fax:
Mailing address:
  • Phone: 831-427-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005736
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number803410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: