Provider Demographics
NPI:1164617809
Name:CAVAZOS, SAN JUANITA A (SLP-A)
Entity Type:Individual
Prefix:MRS
First Name:SAN JUANITA
Middle Name:A
Last Name:CAVAZOS
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 GARRISON DR
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-5021
Mailing Address - Country:US
Mailing Address - Phone:956-244-0032
Mailing Address - Fax:
Practice Address - Street 1:711 N SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-5264
Practice Address - Country:US
Practice Address - Phone:956-626-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329762355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant