MEDICARE: GLORIA IMELDA CAVAZOS SLP

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
1	235Z00000X	Speech-Language Pathologist	103436	TX

General Provider Information

NPI Number	:	1285917245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA IMELDA CAVAZOS SLP

Provider Business Mailing Address
First Line	:	7010 NW 100 DR
Second Line	:	A104
City	:	HOUSTON
State	:	TX
Zip	:	77092-2052
Country	:	US
Telephone Number	:	713-462-6060
Fax Number	:	713-462-6066

Provider Business Practice Location Address
First Line	:	7010 NW 100 DR
Second Line	:	A104
City	:	HOUSTON
State	:	TX
Zip	:	77092-2052
Country	:	US
Telephone Number	:	713-462-6060
Fax Number	:	713-462-6066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/26/2011

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Directions to “ GLORIA IMELDA CAVAZOS SLP” Practice Location

Language	Start Address	Practice Location

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