Healthcare Provider Details

I. General information

NPI: 1649383571
Provider Name (Legal Business Name): EDUARDO O. CAVEDA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E KING AVE
SAN DIEGO TX
78384-1838
US

IV. Provider business mailing address

102 E KING AVE
SAN DIEGO TX
78384-1838
US

V. Phone/Fax

Practice location:
  • Phone: 361-279-8804
  • Fax: 361-279-8812
Mailing address:
  • Phone: 361-279-8804
  • Fax: 361-279-8812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDUARDO OTTO CAVEDA
Title or Position: OWNER
Credential: MD
Phone: 361-384-0909