Organization Name: | EL DORADO COMMUNITY SERVICE ECNTER |
NPI Number: | 1003227901 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STAN SHARMA (PRESIDENT) |
Mailing Address: | 123 W E St Ontario |
State: | CA US |
Postal Code: | 917623400 |
Phone Number: | 5622221310 |
Fax Number: | |
NPI Enumeration Date: | 05/13/2014 |
NPI Last Update Date: | 05/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |