Provider Demographics
NPI:1720031685
Name:ERESO, VIRGILIO CELESTE SR (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGILIO
Middle Name:CELESTE
Last Name:ERESO
Suffix:SR
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 1:1917 MEMORIAL DR
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-1861
Mailing Address - Country:US
Mailing Address - Phone:209-538-1985
Mailing Address - Fax:209-538-6836
Practice Address - Street 1:1917 MEMORIAL DR
Practice Address - Street 2:SUITE A-1
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-1861
Practice Address - Country:US
Practice Address - Phone:209-538-1985
Practice Address - Fax:209-538-6836
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A303080207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A303080Medicaid
CA00A303080Medicaid
CAA26047Medicare UPIN