Provider Demographics
NPI:1427448059
Name:CAZARES, LUIS A (MS CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:A
Last Name:CAZARES
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19557
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78760-9557
Mailing Address - Country:US
Mailing Address - Phone:956-225-7029
Mailing Address - Fax:
Practice Address - Street 1:457 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1937
Practice Address - Country:US
Practice Address - Phone:979-968-5865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100295235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist