Basic Information
| Provider Information | |||||||||
| NPI: | 1003825340 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAVAZOS-GONZALEZ | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2216 FUENTE DE GOZO | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785396582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9562074576 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 205 E TORONTO AVE | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785031209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566876155 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 3-1245 | TX | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TC0700X | 31245 | TX | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 831141P | 05 | TX | MEDICAID | 041052-04 | 05 | TX | MEDICAID | H08HW01501 | 01 | TX | BCBS | OTHER |