Healthcare Provider Details

I. General information

NPI: 1861107567
Provider Name (Legal Business Name): ROSE E GARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 6TH AVE NE
DEVILS LAKE ND
58301-3002
US

IV. Provider business mailing address

124 6TH AVE NE
DEVILS LAKE ND
58301-3002
US

V. Phone/Fax

Practice location:
  • Phone: 170-154-4011
  • Fax:
Mailing address:
  • Phone: 701-544-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: