Provider Demographics
NPI:1073232807
Name:CAVAZOS, CAROL G
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:G
Last Name:CAVAZOS
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 1:3033 S PORT AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-2040
Mailing Address - Country:US
Mailing Address - Phone:361-883-0875
Mailing Address - Fax:361-883-2592
Practice Address - Street 1:3033 S PORT AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-2040
Practice Address - Country:US
Practice Address - Phone:361-883-0875
Practice Address - Fax:361-883-2592
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100039183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician