Provider Demographics
NPI:1578507604
Name:IGNACIO, ELMER PEDERE (MD)
Entity type:Individual
Prefix:DR
First Name:ELMER
Middle Name:PEDERE
Last Name:IGNACIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:N/A
Mailing Address - Street 1:2700 REMBRANDT PL
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-0349
Mailing Address - Country:US
Mailing Address - Phone:209-521-5731
Mailing Address - Fax:
Practice Address - Street 1:1524 MCHENRY AVE.
Practice Address - Street 2:STE. 450
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-557-6201
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA421032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3427319Medicaid
CA00A421030Medicare ID - Type Unspecified
CA3427319Medicaid