Healthcare Provider Details

I. General information

NPI: 1619898913
Provider Name (Legal Business Name): JERRY GARZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N HORIZON LN
SANTA FE NM
87507-9076
US

IV. Provider business mailing address

15 N HORIZON LN
SANTA FE NM
87507-9076
US

V. Phone/Fax

Practice location:
  • Phone: 505-257-8344
  • Fax:
Mailing address:
  • Phone: 505-257-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: