Provider Demographics
NPI:1700668845
Name:EAGLEVIEWPSYCHIATRY
Entity Type:Organization
Organization Name:EAGLEVIEWPSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANVIR
Authorized Official - Middle Name:
Authorized Official - Last Name:PANNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-999-1418
Mailing Address - Street 1:8765 HERITAGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3945
Mailing Address - Country:US
Mailing Address - Phone:916-999-1418
Mailing Address - Fax:916-288-8886
Practice Address - Street 1:428 J ST STE 400
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2394
Practice Address - Country:US
Practice Address - Phone:916-999-1418
Practice Address - Fax:916-288-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty