Basic Information
| Provider Information | |||||||||
| NPI: | 1780040279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAVAZOS | ||||||||
| FirstName: | HUMBERTO | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 PATSY BOX 4205 | ||||||||
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| City: | HIDALGO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785572750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566556500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5501 S MCCOLL RD | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785399152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563628677 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2016 | ||||||||
| LastUpdateDate: | 01/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP129951 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.