1134421795 NPI number — DR. ALEJANDRO CAVAZOS DDS

Table of content: DR. ALEJANDRO CAVAZOS DDS (NPI 1134421795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134421795 NPI number — DR. ALEJANDRO CAVAZOS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAVAZOS
Provider First Name:
ALEJANDRO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAVAZOS
Provider Other First Name:
ALEX
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134421795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
523 MED CT STE 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-3359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-281-5115
Provider Business Mailing Address Fax Number:
210-455-5891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
523 MED CT STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-3359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-281-5115
Provider Business Practice Location Address Fax Number:
210-455-5891
Provider Enumeration Date:
12/02/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  25539 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)