| El Dorado Behavioral Health | |
|
6612 E Carondelet Dr Tucson AZ 85710-2119 | |
| (520) 214-4296 | |
| Not Available |
| Full Name | El Dorado Behavioral Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 6612 E Carondelet Dr, Tucson, Arizona |
| Authorized Official Name and Position | Eitan Morse (OWNER) |
| Authorized Official Contact | 5202071585 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| El Dorado Behavioral Health 6612 E Carondelet Dr Tucson AZ 85710-2119 Ph: (520) 214-4296 | El Dorado Behavioral Health 6612 E Carondelet Dr Tucson AZ 85710-2119 Ph: (520) 214-4296 |
| NPI Number | 1649991902 |
|---|---|
| Provider Enumeration Date | 09/06/2022 |
| Last Update Date | 09/06/2022 |
| Certification Date | 09/06/2022 |
| Medicare PECOS PAC ID | 3678940491 |
|---|---|
| Medicare Enrollment ID | O20221108003175 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649991902 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Raul J Rodriguez Sora |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811097538 PECOS PAC ID: 2961420088 Enrollment ID: I20051108000186 |
| Provider Name | Kerri A Akers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659681682 PECOS PAC ID: 6901093582 Enrollment ID: I20110418000627 |
| Provider Name | Colleen M Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598390791 PECOS PAC ID: 9436243318 Enrollment ID: I20200415001811 |
| Provider Name | David A Prince |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740757400 PECOS PAC ID: 2668889858 Enrollment ID: I20210406001994 |
| Provider Name | Marisol Ramirez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538730312 PECOS PAC ID: 7618370560 Enrollment ID: I20210729001568 |
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