Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 3-1245 | TX |
N | 103TC0700X | Clinical Psychologist | 3-1245 | TX |
Y | 103G00000X | Clinical Psychologist | 31245 | TX |
Y | 103TC0700X | Clinical Psychologist | 31245 | TX |
NPI | 1003825340 |
---|---|
Provider Name | Dr. Cynthia Cavazos-Gonzalez |
First Address | Edinburg, TX 78539-6582 |
Second Address | Mcallen, TX 78503-1209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 17/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041052-04 | (05) | TX |
831141P | (05) | TX |
H08HW01501 | BCBS (01) | TX |