Healthcare Provider Details

I. General information

NPI: 1487295374
Provider Name (Legal Business Name): AMARIS NICOLE GARZA RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMARIS NICOLE TETER

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12407 N MOPAC EXPY
AUSTIN TX
78758-2475
US

IV. Provider business mailing address

646 S FLORES ST
SAN ANTONIO TX
78204-1219
US

V. Phone/Fax

Practice location:
  • Phone: 855-481-1149
  • Fax:
Mailing address:
  • Phone: 855-481-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT86155
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: