MEDICARE: YESELI MARIE CAVAZOS APRN

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	363LF0000X	Family Nurse Practitioner	1028924	TX

General Provider Information

NPI Number	:	1811575772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESELI MARIE CAVAZOS APRN

Provider Business Mailing Address
First Line	:	7710 SMOKEY WOOD LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-2427
Country	:	US
Telephone Number	:	713-884-7845
Fax Number	:

Provider Business Practice Location Address
First Line	:	5367 W RICHEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3323
Country	:	US
Telephone Number	:	281-895-3008
Fax Number	:

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

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	04/20/2021

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