Provider Demographics
NPI:1174803852
Name:ELDORADO COMMUNITY SERVICE CENTER
Entity type:Organization
Organization Name:ELDORADO COMMUNITY SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PRAMESH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-254-6630
Mailing Address - Street 1:PO BOX 801809
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91380-1809
Mailing Address - Country:US
Mailing Address - Phone:661-254-6630
Mailing Address - Fax:661-254-6644
Practice Address - Street 1:8207 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2521
Practice Address - Country:US
Practice Address - Phone:562-692-2522
Practice Address - Fax:562-695-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700882156Medicaid