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NPI Code Detail

MEDICARE: DR. GABRIEL MAURICIO GARZA SADA PH.D.

MEDICARE: DR. GABRIEL MAURICIO GARZA SADA PH.D.
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
1103TC2200XClinical Child & Adolescent Psychologist06555MD
2103TC0700XClinical PsychologistPS2559ME

General Provider Information

NPI Number : 1144666355
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GABRIEL MAURICIO GARZA SADA PH.D.
Provider Business Mailing Address
First Line : 707 SABLE OAKS DR STE 230
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-6954
Country : US
Telephone Number : 603-883-0005
Fax Number :
Provider Business Practice Location Address
First Line : 707 SABLE OAKS DR STE 230
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-6954
Country : US
Telephone Number : 603-883-0005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2013
Last Update Date : 04/12/2024

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