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NPI Code Detail

MEDICARE: DR. CYNTHIA CAVAZOS-GONZALEZ PH.D

MEDICARE: DR. CYNTHIA CAVAZOS-GONZALEZ PH.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical Neuropsychologist3-1245TX
2103TC0700XClinical Psychologist31245TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3H08HW01501OTHERTXBCBS

General Provider Information

NPI Number : 1003825340
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CYNTHIA CAVAZOS-GONZALEZ PH.D
Provider Business Mailing Address
First Line : 2216 FUENTE DE GOZO
Second Line :
City : EDINBURG
State : TX
Zip : 78539-6582
Country : US
Telephone Number : 956-207-4576
Fax Number :
Provider Business Practice Location Address
First Line : 205 E TORONTO AVE
Second Line :
City : MCALLEN
State : TX
Zip : 78503-1209
Country : US
Telephone Number : 956-687-6155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 01/17/2019

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