Healthcare Provider Details

I. General information

NPI: 1316192826
Provider Name (Legal Business Name): EL DORADO SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 GOLDEN CENTER DR SUITE E
PLACERVILLE CA
95667-6278
US

IV. Provider business mailing address

4300 GOLDEN CENTER DR SUITE E
PLACERVILLE CA
95667-6278
US

V. Phone/Fax

Practice location:
  • Phone: 530-344-1687
  • Fax: 530-344-1561
Mailing address:
  • Phone: 530-344-1687
  • Fax: 530-344-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TINA M HEINRICH
Title or Position: FACILITY ADMINISTRATOR
Credential: RN
Phone: 530-344-1687