Provider Demographics
NPI:1679184956
Name:CAVAZOS, JAVIER EDUARDO
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:EDUARDO
Last Name:CAVAZOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S OHIO AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-2612
Mailing Address - Country:US
Mailing Address - Phone:956-903-4335
Mailing Address - Fax:
Practice Address - Street 1:111 S OHIO AVE STE 1
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2612
Practice Address - Country:US
Practice Address - Phone:956-903-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1002657332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies