Provider Demographics
NPI:1124774682
Name:DE LA GARZA, FERNANDA
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:
Last Name:DE LA GARZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SW 6TH AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-1338
Mailing Address - Country:US
Mailing Address - Phone:305-335-3535
Mailing Address - Fax:
Practice Address - Street 1:3800 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2243
Practice Address - Country:US
Practice Address - Phone:352-955-6706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool