Provider Demographics
NPI:1114405867
Name:CAVAZOS, SANDRA G
Entity Type:Individual
Prefix:
First Name:SANDRA
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 1:613 W SESAME DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7930
Mailing Address - Country:US
Mailing Address - Phone:956-399-4500
Mailing Address - Fax:956-399-4505
Practice Address - Street 1:613 W SESAME DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7930
Practice Address - Country:US
Practice Address - Phone:956-399-4500
Practice Address - Fax:956-399-4505
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547055163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse