Provider Demographics
NPI:1699963561
Name:CAVAZOS, MARIA COOKIE
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:COOKIE
Last Name:CAVAZOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341
Mailing Address - Country:US
Mailing Address - Phone:209-381-1026
Mailing Address - Fax:209-381-1056
Practice Address - Street 1:260 E 15TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341
Practice Address - Country:US
Practice Address - Phone:209-381-1026
Practice Address - Fax:209-381-1056
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN195256164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse