| Eleos Cognitive Center | |
|
23180 Hemlock Ave Ste 100 Moreno Valley CA 92557-8001 | |
| (951) 500-1152 | |
| Not Available |
| Full Name | Eleos Cognitive Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 23180 Hemlock Ave Ste 100, Moreno Valley, California |
| Authorized Official Name and Position | Joel A Pengson (CEO) |
| Authorized Official Contact | 9515001152 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eleos Cognitive Center Po Box 220 Moreno Valley CA 92556-0220 Ph: (951) 266-9880 | Eleos Cognitive Center 23180 Hemlock Ave Ste 100 Moreno Valley CA 92557-8001 Ph: (951) 500-1152 |
| NPI Number | 1710450036 |
|---|---|
| Provider Enumeration Date | 01/09/2019 |
| Last Update Date | 02/07/2023 |
| Certification Date | 02/07/2023 |
| Medicare PECOS PAC ID | 0143639112 |
|---|---|
| Medicare Enrollment ID | O20220408000153 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710450036 | NPI | - | NPPES |
| Provider Name | Joel A Pengson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720018237 PECOS PAC ID: 9638135353 Enrollment ID: I20041204000223 |
| Provider Name | Venugopal Depala |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699877480 PECOS PAC ID: 1759347990 Enrollment ID: I20080206000406 |
| Provider Name | Mayra E Garcia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386044709 PECOS PAC ID: 2264837061 Enrollment ID: I20210817001780 |
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