Eaton Pediatrics & Medical Corp.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A50064 Issued in CA

Legal business name

EATON PEDIATRICS & MEDICAL CORP.

Practice address

518 W Eaton Ave
Tracy, CA 95376-3422

Phone

(209) 833-2228

NPI assigned

Sep 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Manuel R De la Cruz, M.D.

Title

President

Phone

(209) 833-2228

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336249713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 W EATON AVE",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953763422",
            "telephone_number": "209-833-2228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 W EATON AVE",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953763422",
            "telephone_number": "209-833-2228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EATON PEDIATRICS & MEDICAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DE LA CRUZ",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-833-2228",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A50064",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A74123",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP ID#",
            "identifier": "ZZZ01387Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dva Healthcare Renal Care Inc (Tracy Dialysis)
• Melissa K Dyer, COUNSELOR 1
• Michael Richard Earle, D.D.S.
• Eaton Optometric Group
• Eaton Optometric Group, Inc.
• Ricardo Echon, FNP-C
• Eco Sound LLC
• Ecologically Sound Medical SRV
• David Alan Edelsohn, MD
• Josie Egami

• Pediatrics Physician in Tracy, CA
• Providers in Tracy, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.