Healthcare Provider Details

I. General information

NPI: 1285017541
Provider Name (Legal Business Name): CAROLINA GARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 HIGGINS RD
SAN ANTONIO TX
78217-1252
US

IV. Provider business mailing address

14207 HIGGINS RD
SAN ANTONIO TX
78217-1252
US

V. Phone/Fax

Practice location:
  • Phone: 210-826-4492
  • Fax: 210-826-7887
Mailing address:
  • Phone: 210-826-4492
  • Fax: 210-826-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number110148
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: