Provider Demographics
NPI:1366750424
Name:CAVAZOS, CARLOTTA L (PA-C)
Entity type:Individual
Prefix:MS
First Name:CARLOTTA
Middle Name:L
Last Name:CAVAZOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1500 OWENS ST
Mailing Address - Street 2:BOX 3004
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2332
Mailing Address - Country:US
Mailing Address - Phone:415-353-2888
Mailing Address - Fax:415-353-2222
Practice Address - Street 1:1500 OWENS ST
Practice Address - Street 2:BOX 3004
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2332
Practice Address - Country:US
Practice Address - Phone:415-353-2888
Practice Address - Fax:415-353-2222
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17870363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical