EL DORADO COMMUNITY SERVICE CENTER (NPI# 1114096872) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114096872 |
| Entity Type | Organization |
| Organization Name | EL DORADO COMMUNITY SERVICE CENTER |
| Other Organization Name | VENICE MEDICAL & MENTAL HEALTH SERVICES |
| Practice Address |
717 Lincoln Blvd Venice CA 90291-2845 |
| Mailing Address |
Po Box 801809 Valencia CA 91380-1809 |
| Practice Telephone | 3103999883 |
| Practice Fax Number | 3103999678 |
| Mailing Telephone | 6612546630 |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2017-01-31 |
| Authorized Official Name | SEANJAY RAMANAND SHARMA (DIRECTOR) |
| Authorized Official Telephone | 6612546630 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
960001025 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | CMM70719F | 05 |
| Other Name | Type Code |
|---|---|
| VENICE MEDICAL & MENTAL HEALTH SERVICES | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427469386 | El Dorado Community Service Center | Clinic/Center | 21619 Norwalk Blvd, Hawaiian Gardens, CA 90716-1123 | 2014-05-14 |
| 1609287564 | El Dorado Community Service Center | Clinic/Center | 14611 Hawthorne Blvd, Lawndale, CA 90260-1522 | 2014-05-14 |
| 1083040216 | El Dorado Community Service Center | Clinic/Center | 540 S San Pedro St, Los Angeles, CA 90013-2102 | 2013-09-19 |
| 1912254418 | El Dorado Community Service Center | Clinic/Center | 472 S Citrus Ave, Azusa, CA 91702-4733 | 2012-08-14 |
| 1255619375 | El Dorado Community Service Center | Clinic/Center | 609 E 18th St, Bakersfield, CA 93305-5616 | 2011-07-22 |
| 1932338241 | El Dorado Community Service Center | Clinic/Center | 1733 Euclid Ave, San Diego, CA 92105-5414 | 2009-07-08 |
| 1568677235 | El Dorado Community Service Center | Clinic/Center | 5200 San Gabriel Pl Suite B & C, Pico Rivera, CA 90660-2497 | 2007-05-14 |
| 1508935230 | El Dorado Community Service Center | Clinic/Center | 24625 Arch St, Newhall, CA 91321-1111 | 2006-11-07 |
| 1518036037 | El Dorado Community Service Center | Clinic/Center | 1010 S Union Ave, Bakersfield, CA 93307-3642 | 2006-11-07 |
| 1821167305 | El Dorado Community Service Center | Clinic/Center | 21507 Norwalk Blvd, Hawaiian Gardens, CA 90716-1121 | 2006-11-07 |
| Street Address |
717 LINCOLN BLVD |
| City | VENICE |
| State | CA |
| Zip Code | 90291-2845 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194323659 | Antonio De Jesus Sanchez | Counselor | 717 Lincoln Blvd, Venice, CA 90291-2845 | 2020-10-15 |
| 1093360331 | Sandra Diane Kellar | Counselor | 717 Lincoln Blvd, Venice, CA 90291-2845 | 2019-08-05 |
| 1215405816 | John Edward Rudegeair | Counselor | 717 Lincoln Blvd, Venice, CA 90291-2845 | 2018-11-13 |
| 1922511401 | Christiana Dorian Grotlisch | Counselor | 717 Lincoln Blvd, Venice, CA 90291-2845 | 2017-11-07 |
| 1184144826 | Estefania Bernabe | Counselor | 717 Lincoln Blvd, Venice, CA 90291-2845 | 2017-06-23 |
| 1730636598 | Daniel Bolander | Counselor | 717 Lincoln Blvd, Venice, CA 90291-2845 | 2016-09-08 |
| 1184179525 | American Health Services | Exclusive Provider Organization | 717 Lincoln Blvd, Venice, CA 90291-2845 | 2016-08-15 |
| 1588016489 | Cesia Delacruz | Licensed Vocational Nurse | 717 Lincoln Blvd, Venice, CA 90291 | 2016-07-05 |
| 1851774913 | Wade Taylor | Counselor | 717 Lincoln Blvd, Venice, CA 90291-2845 | 2015-07-07 |
| 1689067894 | Stan Carl Perryman II | Case Manager/Care Coordinator | 717 Lincoln Blvd, Venice, CA 90291-2845 | 2015-03-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033629837 | Dylan Booth | Dentist | 601 Vernon Ave, Venice, CA 90291 | 2017-10-05 |
| 1467979500 | Linda Sittler | Registered Nurse | 1025 Palms Ave, Venice, CA 90291 | 2017-08-29 |
| 1003218660 | Patricia Guadalupe Rivas | Counselor | 717 Lincoln Blvd., Venice, CA 90291 | 2014-09-25 |
| 1497016877 | Carrie Lynn Kowalski | Physician Assistant | 604 Rose Avenue, Venice, CA 90291 | 2012-06-02 |
| 1821364761 | Cheryl Lynn Perkins | Nutritionist | 215 Culver Boulevard, # 5203, Playa Del Rey, CA 90291 | 2012-03-26 |
| 1629391875 | James L. Hoff | Optometrist | 1636 Abbot Kinney Blvd., Venice, CA 90291 | 2010-03-02 |
| 1720315096 | Kristen Nicol Leishman | Counselor | 911 Coeur D'alene Ave, Venice, CA 90291 | 2009-11-06 |
| 1922237882 | David Anthony Garcia | Physician Assistant | 15031 Rinaldi St., Providence Holy Cross Medical Center Ed, Mission Hills, CA 90291 | 2009-07-13 |
| 1548411010 | David Watts | Acupuncturist | 307 S. Robertson Blvd, Beverly Hills, CA 90291 | 2008-10-02 |
| 1184891699 | Judy Alexander | Voluntary or Charitable | 204 Hampton Drive, St Joseph Center, Venice, CA 90291 | 2008-05-14 |
| Find all providers in zip 90291 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.