Provider Demographics
NPI:1154925303
Name:GARZON, RAQUEL (DHSC, RDN)
Entity type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:
Last Name:GARZON
Suffix:
Gender:F
Credentials:DHSC, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2472 GILA BEND LOOP
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4184
Mailing Address - Country:US
Mailing Address - Phone:407-687-9772
Mailing Address - Fax:
Practice Address - Street 1:2472 GILA BEND LOOP
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4184
Practice Address - Country:US
Practice Address - Phone:407-687-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-1410133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered