Provider Demographics
NPI:1447219662
Name:GO, ELEUTERIO ARCANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEUTERIO
Middle Name:ARCANGEL
Last Name:GO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7446 RIVER NINE DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9221
Mailing Address - Country:US
Mailing Address - Phone:209-985-4813
Mailing Address - Fax:
Practice Address - Street 1:809 SYLVAN AVE
Practice Address - Street 2:STE. 500A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1500
Practice Address - Country:US
Practice Address - Phone:209-521-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68296174400000X, 2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6213236Medicaid
CAZZZ01404ZOtherMEDICARE GROUP ID
CA00A682962OtherMEDICARE PPIN
CAG65869Medicare UPIN
CA6213236Medicaid