Provider Demographics
NPI:1730523275
Name:GARZA, ERASMO
Entity type:Individual
Prefix:MR
First Name:ERASMO
Middle Name:
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 1:431 BRIGHTON KNOLLS DR
Mailing Address - Street 2:
Mailing Address - City:BRINKLOW
Mailing Address - State:MD
Mailing Address - Zip Code:20862-9709
Mailing Address - Country:US
Mailing Address - Phone:301-774-5758
Mailing Address - Fax:
Practice Address - Street 1:431 BRIGHTON KNOLLS DR
Practice Address - Street 2:
Practice Address - City:BRINKLOW
Practice Address - State:MD
Practice Address - Zip Code:20862-9709
Practice Address - Country:US
Practice Address - Phone:301-774-5758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM03402225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist