MEDICARE: SELENA MIREYA GARZA MSW

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	1041C0700X	Clinical Social Worker	29073	MN

General Provider Information

NPI Number	:	1629798525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELENA MIREYA GARZA MSW

Provider Business Mailing Address
First Line	:	824 HALL AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55107-3364
Country	:	US
Telephone Number	:	701-740-1397
Fax Number	:

Provider Business Practice Location Address
First Line	:	824 HALL AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55107-3364
Country	:	US
Telephone Number	:	701-740-1397
Fax Number	:

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

Provider Enumeration Date	:	08/31/2022
Last Update Date	:	04/14/2023

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