Healthcare Provider Details

I. General information

NPI: 1427025485
Provider Name (Legal Business Name): RICARDO GARZA I.D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 NIDER BLVD SUITE 100
NORFOLK VA
23521-2701
US

IV. Provider business mailing address

734 DUNEDIN RD APT. 3F
PORTSMOUTH VA
23701-2314
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7406
  • Fax: 757-314-7450
Mailing address:
  • Phone: 757-968-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: