El Dorado Community Service Center
Organization Active NPI Primary Care Clinic/Center · Venice, CA
NPI 1114096872 · NPPES record last updated Jan 31, 2017
Key facts
- NPI
- 1114096872
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- 960001025 (CA)
- Legal business name
- EL DORADO COMMUNITY SERVICE CENTER
- Practice address
- 717 Lincoln Blvd
Venice, CA 90291-2845 - Phone
- (310) 399-9883
- Fax
- (310) 399-9678
- NPI assigned
- Nov 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Seanjay Ramanand Sharma
- Title
- Director
- Phone
- (661) 254-6630
Other NPIs on the same Medicare enrollment 9
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050111000696 | CA | Part B Supplier - Clinic/Group Practice | 4183672645 |
Receives reassigned benefits from 15 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Azusa, CA; Venice, CA; Van Nuys, CA; San Francisco, CA; Palmdale, CA; Newhall, CA; Los Angeles, CA; Lawndale, CA… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 960001025 | CA | Yes |
Addresses
Primary practice location
717 Lincoln Blvd
Venice, CA 90291-2845
Mailing address
PO Box 801809
Valencia, CA 91380-1809
Phone (661) 254-6630
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CMM70719F | Medicaid | CA |
Other names
- VENICE MEDICAL & MENTAL HEALTH SERVICES
Other providers in Venice, CA
- Scott Albert Dunn
- Danielle Dunne
- Tomeka Dunnigan
- Alan Ebling
- Brandon Edenedo
- Mary Hunter Ellegood
- Emily Elson
- Mary Eno
- Adriana Eversole
- Evo Health and Wellness, LLC
All providers in Venice, CA · Primary Care Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.