MEDICARE: KELLY R GARZA

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	130205	CA

General Provider Information

NPI Number	:	1689247397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY R GARZA

Provider Business Mailing Address
First Line	:	6510 CRESCENT ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-2935
Country	:	US
Telephone Number	:	303-501-6603
Fax Number	:

Provider Business Practice Location Address
First Line	:	6510 CRESCENT ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-2935
Country	:	US
Telephone Number	:	303-501-6603
Fax Number	:

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

Provider Enumeration Date	:	07/20/2021
Last Update Date	:	12/05/2025

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