MEDICARE: MARY LUZ GARZON

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	106S00000X	Behavior Technician	RBT-24-321719	FL

General Provider Information

NPI Number	:	1396501144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LUZ GARZON

Provider Business Mailing Address
First Line	:	485 SE FALLON DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-2634
Country	:	US
Telephone Number	:	126-722-8915
Fax Number	:

Provider Business Practice Location Address
First Line	:	485 SE FALLON DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-2634
Country	:	US
Telephone Number	:	267-228-9149
Fax Number	:

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

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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Directions to “ MARY LUZ GARZON ” Practice Location

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