Provider Demographics
NPI:1528573169
Name:CAVAZOS, LIBRADO OMAR (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LIBRADO
Middle Name:OMAR
Last Name:CAVAZOS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E. SAVANNAH AVE. BLDG B
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-9700
Mailing Address - Country:US
Mailing Address - Phone:956-686-7611
Mailing Address - Fax:956-618-3164
Practice Address - Street 1:110 E SAVANNAH AVE # 203
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-686-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily