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General NPI Number Information
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NPI Number | 1063698041
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Entity Type | Organization
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Legal Business Name | VIRGILIO C. ERESO M.D. INC.
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Dates
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Enumeration Date | 01/21/2008
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 500 COFFEE RD SUITE A
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City | MODESTO
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State | CA
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Zip | 95355-4926
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Country | US
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Telephone | 209-579-7461
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Fax | 209-579-7465
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Provider Business Mailing Address
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Address Line | 500 COFFEE RD SUITE A
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City | MODESTO
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State | CA
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Zip | 95355-4926
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Country | US
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Telephone | 209-579-7461
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Fax | 209-579-7465
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIRGILIO C. ERESO
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Credential | M.D.
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Telephone | 209-579-7461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A30308
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License Number State | CA
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