Basic Information
| Provider Information | |||||||||
| NPI: | 1942243498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAVAZOS | ||||||||
| FirstName: | ABEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OTR,CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 SPURS LN | ||||||||
| Address2: | 310 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105587025 | ||||||||
| FaxNumber: | 2105584664 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 SPURS LN | ||||||||
| Address2: | 310 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105587025 | ||||||||
| FaxNumber: | 2105584664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 07/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 109202 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 9579557 | 01 | TX | CIGNA | OTHER | 7362700 | 01 | TX | AETNA | OTHER | 8T4227 | 01 | TX | BCBS | OTHER |