Healthcare Provider Details

I. General information

NPI: 1619968088
Provider Name (Legal Business Name): ANTONIA GARCIA-CAVAZOS PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E SAVANNAH AVE STE 20
MCALLEN TX
78503-1728
US

IV. Provider business mailing address

PO BOX 4449
MCALLEN TX
78502-4449
US

V. Phone/Fax

Practice location:
  • Phone: 956-618-5209
  • Fax: 956-618-5210
Mailing address:
  • Phone: 956-618-5209
  • Fax: 956-618-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA02022
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: