MEDICARE: DR. RAQUEL GARZON DHSC, RDN

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	133V00000X	Registered Dietitian	LD-1410	NM

General Provider Information

NPI Number	:	1154925303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAQUEL GARZON DHSC, RDN

Provider Business Mailing Address
First Line	:	2472 GILA BEND LOOP
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4184
Country	:	US
Telephone Number	:	407-687-9772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2472 GILA BEND LOOP
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4184
Country	:	US
Telephone Number	:	407-687-9772
Fax Number	:

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

Provider Enumeration Date	:	11/29/2020
Last Update Date	:	11/29/2020

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