Provider Demographics
NPI:1013661966
Name:GARZA, PATRICK ANTHONY
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ANTHONY
Last Name:GARZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5265
Mailing Address - Country:US
Mailing Address - Phone:786-447-3908
Mailing Address - Fax:
Practice Address - Street 1:7610 NW 15TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-5265
Practice Address - Country:US
Practice Address - Phone:786-447-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-197796106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician