MEDICARE: DAVID GARZA DE LA ROSA

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1558197293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID GARZA DE LA ROSA

Provider Business Mailing Address
First Line	:	PO BOX 6096
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95927-6096
Country	:	US
Telephone Number	:	530-214-9238
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 SPRINGFIELD DR APT 147
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95928-7313
Country	:	US
Telephone Number	:	530-214-9238
Fax Number	:

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

Provider Enumeration Date	:	09/10/2024
Last Update Date	:	09/10/2024

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Directions to “ DAVID GARZA DE LA ROSA ” Practice Location

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