Provider Demographics
NPI:1336622976
Name:CAVAZOS, MAYRA (RN)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:CAVAZOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 JJ JORGE ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5691
Mailing Address - Country:US
Mailing Address - Phone:956-615-3411
Mailing Address - Fax:
Practice Address - Street 1:4646 CORONA DR STE 260
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4395
Practice Address - Country:US
Practice Address - Phone:361-334-1609
Practice Address - Fax:361-906-0478
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX924966163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty