El Dorado County Community Health Center
Organization Active NPI Community/Retail Pharmacy · Cameron Park, CA
NPI 1669829628 · NPPES record last updated Jul 9, 2025
Key facts
- NPI
- 1669829628
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- EL DORADO COUNTY COMMUNITY HEALTH CENTER
- Practice address
- 3104 Ponte Morino Dr Ste 100
Cameron Park, CA 95682-8282 - Phone
- (530) 556-2007
- Fax
- (530) 350-6331
- NPI assigned
- May 19, 2016
- Organization subpart
- No
Authorized official
- Name
- Judy Stein
- Title
- Cfo
- Phone
- (530) 748-2327
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 1
Practitioners 2
-
Dennis Kevin Caskey, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250401001450 | CA | Part B Supplier - Mass Immunization (Roster Biller Only) | 5294258133 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cameron Park, CA; W Sacramento, CA |
National Provider Directory
- Tax ID family
- Imgrx Salud Inc
Locations
3100 Ponte Morino Dr
Ste 120
Cameron Park, CA 95682
3104 Ponte Morino Dr
Ste 100
Cameron Park, CA 95682
Phone (305) 556-2056
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
3104 Ponte Morino Dr Ste 100
Cameron Park, CA 95682-8282
Mailing address
3104 Ponte Morino Dr Ste 100
Cameron Park, CA 95682-8282
Phone (530) 556-2007
Other names
- El Dorado Community Pharmacy
Other providers in Cameron Park, CA
- Everett Brantley Dyer
- Wendy Zilch Dyer
- David W. Egbert
- El Dorado County Community Health Center
- El Dorado County Community Health Center
- El Dorado Hematology and Medical Oncology
- Roberta Jean Esfandiarfard
- Charles a. Aubrey Eubanks
- Rebecca Falkenstern
- Deborah Ball Fallon
All providers in Cameron Park, CA · Community/Retail Pharmacy in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2025. 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.