Provider Demographics
NPI:1336626332
Name:CAVAZOS, CRISELDA (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CRISELDA
Middle Name:
Last Name:CAVAZOS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 W SAGE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-2790
Mailing Address - Country:US
Mailing Address - Phone:361-228-8600
Mailing Address - Fax:
Practice Address - Street 1:85 NE LOOP 410 STE 500
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5866
Practice Address - Country:US
Practice Address - Phone:210-822-0475
Practice Address - Fax:210-822-0485
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health