1295766228 NPI number — EDUARDO O CAVEDA MD PA

Table of content: (NPI 1295766228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295766228 NPI number — EDUARDO O CAVEDA MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDUARDO O CAVEDA MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295766228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 ARMSTRONG STREET
Provider Second Line Business Mailing Address:
BOX 1290
Provider Business Mailing Address City Name:
ORANGE GROVE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-384-0909
Provider Business Mailing Address Fax Number:
361-384-9998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 ARMSTRONG STREET
Provider Second Line Business Practice Location Address:
BOX 1290
Provider Business Practice Location Address City Name:
ORANGE GROVE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-384-0909
Provider Business Practice Location Address Fax Number:
361-384-9998
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAVEDA
Authorized Official First Name:
EDUARDO
Authorized Official Middle Name:
OTTO
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
361-384-0909

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  K4017 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 148743101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 153997501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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