Healthcare Provider Details

I. General information

NPI: 1245229434
Provider Name (Legal Business Name): DR. REBECCA C CAVAZOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8715 VILLAGE DR SUITE 418
SAN ANTONIO TX
78217-5405
US

IV. Provider business mailing address

367 E RAMSEY RD
SAN ANTONIO TX
78216-4636
US

V. Phone/Fax

Practice location:
  • Phone: 210-656-3040
  • Fax: 210-656-6419
Mailing address:
  • Phone: 210-349-9300
  • Fax: 210-366-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberH2292
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: