Organization
EL DORADO COMMUNITY SERVICE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PRAMESH PRAKASH SHARMA (SR V P)
(661) 254-6630
Entity
Organization
Contact information
Practice address
5200 SAN GABRIEL PL SUITE B & C, PICO RIVERA, CA 90660-2497
(562) 222-1331
(562) 222-1322
Mailing address
26460 SUMMIT CIR, SANTA CLARITA, CALIFORNIA, CA 91350-2991
(661) 254-6630
(661) 254-6630
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
19AP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-148
STATE NTP LICENSE
CA
01
—
19AP
ADPA
CA
Enumeration date
05/14/2007
Last updated
01/08/2020
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