Healthcare Provider Details

I. General information

NPI: 1003825340
Provider Name (Legal Business Name): CYNTHIA CAVAZOS-GONZALEZ PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

IV. Provider business mailing address

2216 FUENTE DE GOZO
EDINBURG TX
78539-6582
US

V. Phone/Fax

Practice location:
  • Phone: 956-687-6155
  • Fax:
Mailing address:
  • Phone: 956-207-4576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3-1245
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31245
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: