Basic Information
| Provider Information | |||||||||
| NPI: | 1174939128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DE LA GARZA | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2737 W CECIL AVE | ||||||||
| Address2: | |||||||||
| City: | DELANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932151821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617212345 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2737 W CECIL AVE | ||||||||
| Address2: | |||||||||
| City: | DELANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932151821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617212345 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2014 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY30133 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.