Healthcare Provider Details

I. General information

NPI: 1629931878
Provider Name (Legal Business Name): MICHAEL JAMES GARZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 E PACIFIC AVE
TULARE CA
93274-1106
US

IV. Provider business mailing address

1771 E PACIFIC AVE
TULARE CA
93274-1106
US

V. Phone/Fax

Practice location:
  • Phone: 559-686-1675
  • Fax:
Mailing address:
  • Phone: 559-686-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240167644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: