Provider Demographics
NPI:1487342705
Name:GARZA-WAGGONER, ROSETTA (LVN)
Entity type:Individual
Prefix:
First Name:ROSETTA
Middle Name:
Last Name:GARZA-WAGGONER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83074 LAURENCE DR
Mailing Address - Street 2:
Mailing Address - City:THERMAL
Mailing Address - State:CA
Mailing Address - Zip Code:92274-9094
Mailing Address - Country:US
Mailing Address - Phone:760-878-8202
Mailing Address - Fax:
Practice Address - Street 1:80925 CA-111
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-342-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN286446164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse