Provider Demographics
NPI:1053890053
Name:GARZA, NIDIA MARISOL (BS ASSISTANT-SLP)
Entity type:Individual
Prefix:MS
First Name:NIDIA
Middle Name:MARISOL
Last Name:GARZA
Suffix:
Gender:F
Credentials:BS ASSISTANT-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8472
Mailing Address - Country:US
Mailing Address - Phone:956-668-1203
Mailing Address - Fax:956-668-1462
Practice Address - Street 1:2215 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8472
Practice Address - Country:US
Practice Address - Phone:956-668-1203
Practice Address - Fax:956-668-1462
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX357072355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty