MEDICARE: JUDY GARZA M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1053314765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY GARZA M.S.

Provider Business Mailing Address
First Line	:	2230 PRINCETON AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1160
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E 28TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-3723
Country	:	US
Telephone Number	:	612-863-2729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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