Provider Demographics
NPI:1043301633
Name:GARZA, KATHLEEN (CNM)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GARZA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 MEDICAL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8703
Mailing Address - Country:US
Mailing Address - Phone:505-434-2229
Mailing Address - Fax:505-439-5705
Practice Address - Street 1:2559 MEDICAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8703
Practice Address - Country:US
Practice Address - Phone:505-434-2229
Practice Address - Fax:505-439-5705
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM549176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX593000OtherREGISTERED NURSE LICENSE
NM549OtherCNM LICENSE