Healthcare Provider Details

I. General information

NPI: 1265096101
Provider Name (Legal Business Name): CARLOS F ELTAGUNDE NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 SANDPIPER AVE
MERCED CA
95340-8372
US

IV. Provider business mailing address

1270 AVIGNON DR
MERCED CA
95348-9547
US

V. Phone/Fax

Practice location:
  • Phone: 866-682-4842
  • Fax: 209-381-4109
Mailing address:
  • Phone: 209-388-9903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95011295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: