Organization
EATON PEDIATRICS & MEDICAL CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANUEL R DE LA CRUZ M.D. (PRESIDENT)
(209) 833-2228
Entity
Organization
Contact information
Practice address
518 W EATON AVE, TRACY, CA 95376-3422
(209) 833-2228
Mailing address
518 W EATON AVE, TRACY, CA 95376-3422
(209) 833-2228
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A50064
CA
208000000X
Pediatrics Physician
A74123
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ01387Z
BLUE SHIELD GROUP ID#
CA
Enumeration date
09/25/2006
Last updated
08/22/2020
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