MEDICARE: EDUARDO O. CAVEDA MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1649383571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUARDO O. CAVEDA MD PA

Provider Business Mailing Address
First Line	:	102 E KING AVE
Second Line	:
City	:	SAN DIEGO
State	:	TX
Zip	:	78384-1838
Country	:	US
Telephone Number	:	361-279-8804
Fax Number	:	361-279-8812

Provider Business Practice Location Address
First Line	:	102 E KING AVE
Second Line	:
City	:	SAN DIEGO
State	:	TX
Zip	:	78384-1838
Country	:	US
Telephone Number	:	361-279-8804
Fax Number	:	361-279-8812

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDUARDO OTTO CAVEDA
Credential	:	MD
Telephone Number	:	361-384-0909

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	08/22/2020

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