Organization
EAG PROFESSIONAL MEDICAL CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELEUTERIO ARCANGEL GO M.D. (PRESIDENT)
(209) 537-4434
Entity
Organization
Contact information
Practice address
1809 CENTRAL AVE STE C, CERES, CA 95307-1806
(209) 537-4434
(209) 551-3255
Mailing address
3512 HILLGLEN AVE, MODESTO, CA 95355-7867
(209) 985-4813
(209) 551-3255
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A68296
CA
2084P0804X
Child & Adolescent Psychiatry Physician
A68296
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A682962
MEDICARE PPIN
CA
05
—
6213236
—
CA
01
—
ZZZ01404Z
MEDICARE GROUP ID
CA
Enumeration date
08/27/2007
Last updated
10/03/2007
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