Provider Demographics
NPI:1285151316
Name:GARZA, FANNY (MD)
Entity type:Individual
Prefix:MRS
First Name:FANNY
Middle Name:
Last Name:GARZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:FANNY
Other - Middle Name:
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:504 S AVENUE F
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6342
Mailing Address - Country:US
Mailing Address - Phone:575-607-6804
Mailing Address - Fax:
Practice Address - Street 1:520 W 5TH ST
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6329
Practice Address - Country:US
Practice Address - Phone:575-356-7074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist