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NPI Code Detail

MEDICARE: LAKEWOOD INTEGRATIVE HEALTH & WELLNESS, PLLC

MEDICARE: LAKEWOOD INTEGRATIVE HEALTH & WELLNESS, PLLC
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
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1417801994
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKEWOOD INTEGRATIVE HEALTH & WELLNESS, PLLC
Provider Business Mailing Address
First Line : 6331 PROSPECT AVE
Second Line :
City : DALLAS
State : TX
Zip : 75214-3938
Country : US
Telephone Number : 214-821-6331
Fax Number : 214-821-6332
Provider Business Practice Location Address
First Line : 6331 PROSPECT AVE
Second Line :
City : DALLAS
State : TX
Zip : 75214-3938
Country : US
Telephone Number : 214-821-6331
Fax Number : 214-821-6332
Authorized Official
Title or Position : OWNER
Name : TARA NICOLE CAVAZOS
Credential : FNP
Telephone Number : 214-821-6331
Provider Enumeration Date : 02/23/2026
Last Update Date : 02/23/2026

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