Provider Demographics
NPI:1396049946
Name:DE LA GARZA, ASHLEY COLLEEN
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:COLLEEN
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 1:7381 PRAIRIE FALCON RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0811
Mailing Address - Country:US
Mailing Address - Phone:702-646-5437
Mailing Address - Fax:
Practice Address - Street 1:7381 PRAIRIE FALCON RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0811
Practice Address - Country:US
Practice Address - Phone:702-646-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker