Provider Demographics
NPI:1154745966
Name:CAVAZOS, DIANA X (RN, MSN, MHSA)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:CAVAZOS
Suffix:X
Gender:F
Credentials:RN, MSN, MHSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N SANTA ROSA ST PH 22
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3284
Mailing Address - Country:US
Mailing Address - Phone:210-716-9592
Mailing Address - Fax:
Practice Address - Street 1:100 N SANTA ROSA ST PH 22
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3284
Practice Address - Country:US
Practice Address - Phone:210-716-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX828334163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse