Healthcare Provider Details

I. General information

NPI: 1164270963
Provider Name (Legal Business Name): JENNIFER ALEXANDRA CAVAZOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 ARTHUR LN
MINOT ND
58701-7275
US

IV. Provider business mailing address

2704 7TH AVE NW
MINOT ND
58703-1889
US

V. Phone/Fax

Practice location:
  • Phone: 956-655-4861
  • Fax:
Mailing address:
  • Phone: 956-655-4861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: