| Eag Professional Medical Corp. | |
|
1809 Central Ave Ste C Ceres CA 95307-1806 | |
| (209) 537-4434 | |
| (209) 551-3255 |
| Full Name | Eag Professional Medical Corp. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1809 Central Ave Ste C, Ceres, California |
| Authorized Official Name and Position | Eleuterio Arcangel Go (PRESIDENT) |
| Authorized Official Contact | 2095374434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eag Professional Medical Corp. 3512 Hillglen Ave Modesto CA 95355-7867 Ph: (209) 985-4813 | Eag Professional Medical Corp. 1809 Central Ave Ste C Ceres CA 95307-1806 Ph: (209) 537-4434 |
| NPI Number | 1841483427 |
|---|---|
| Provider Enumeration Date | 08/27/2007 |
| Last Update Date | 10/03/2007 |
| Medicare PECOS PAC ID | 4880641752 |
|---|---|
| Medicare Enrollment ID | O20050401000955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841483427 | NPI | - | NPPES |
| 00A682962 | Other | CA | MEDICARE PPIN |
| 6213236 | Medicaid | CA | |
| ZZZ01404Z | Other | CA | MEDICARE GROUP ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | A68296 (California) | Primary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | A68296 (California) | Secondary |
| Provider Name | Eleuterio A Go |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447219662 PECOS PAC ID: 5698662104 Enrollment ID: I20040301000512 |
| Provider Name | Medard Sison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922507037 PECOS PAC ID: 8820352057 Enrollment ID: I20180515002925 |
| Provider Name | Sarah Fese Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023413556 PECOS PAC ID: 6901128453 Enrollment ID: I20200617002055 |
| Provider Name | Navneet Kaur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992287437 PECOS PAC ID: 4183038714 Enrollment ID: I20210122000647 |
| Provider Name | Adriel J Go |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669137402 PECOS PAC ID: 0648648618 Enrollment ID: I20230523002550 |
Bhrs Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1904 Richland Ave, Ceres, CA 95307 Phone: 209-525-7411 | |
Telecare Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1904 Richland Ave, Ceres, CA 95307 Phone: 209-800-3300 |