Dr. Edmund Cavazos PLLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

J5084 Issued in TX

Legal business name

DR. EDMUND CAVAZOS PLLC

Practice address

4402 Vance Jackson Rd Ste 100
San Antonio, TX 78230

Phone

(210) 688-7735

Fax

(210) 698-7835

NPI assigned

Jul 10, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Edmund Cavazos III, M.D.

Title

Owner

Phone

(512) 551-2949

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Diane Behnke Castillo, LCSW

  • Clinical Social Worker
  • San Antonio, TX
  • NPI 1912943432
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548806400000",
    "number": "1013272665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 AVENUE A APT 1130",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782151272",
            "telephone_number": "270-779-9257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 VANCE JACKSON RD STE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78230",
            "telephone_number": "210-688-7735",
            "fax_number": "210-698-7835"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2601 La Frontera Blvd",
            "address_2": "2115",
            "address_purpose": "LOCATION",
            "city": "Round Rock",
            "state": "TX",
            "postal_code": "786818033",
            "country_code": "US",
            "telephone_number": "512-551-2949",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DR. EDMUND CAVAZOS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-10",
        "last_updated": "2019-01-30",
        "status": "A",
        "authorized_official_last_name": "CAVAZOS",
        "authorized_official_first_name": "EDMUND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-551-2949",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "J5084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.