MEDICARE: BERNARDO LOPEZCAVAZOS

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	163WE0003X	Emergency Registered Nurse	824553	TX
2	163WH0200X	Home Health Registered Nurse	824553	TX
3	163WM0705X	Medical-Surgical Registered Nurse	824553	TX
4	163W00000X	Registered Nurse	824553	TX

General Provider Information

NPI Number	:	1568269744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARDO LOPEZCAVAZOS

Provider Business Mailing Address
First Line	:	7400 MERTON MINTER ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4404
Country	:	US
Telephone Number	:	210-617-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	7411 JOHN SMITH DR
Second Line	:	SUITE 1205
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-6018
Country	:	US
Telephone Number	:	210-616-8454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	08/28/2025

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Directions to “ BERNARDO LOPEZCAVAZOS ” Practice Location

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