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General NPI Number Information
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NPI Number | 1508861881
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Entity Type | Organization
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Legal Business Name | EL DORADO SURGERY CENTER, INC.
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 01/24/2013
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Provider Practice Location Address
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Address Line | 4300 GOLDEN CENTER DR STE E
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City | PLACERVILLE
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State | CA
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Zip | 95667-6278
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Country | US
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Telephone | 530-344-1687
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Fax | 530-344-1561
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Provider Business Mailing Address
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Address Line | 4300 GOLDEN CENTER DR STE E
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City | PLACERVILLE
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State | CA
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Zip | 95667-6278
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Country | US
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Telephone | 530-344-1687
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Fax | 530-344-1561
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Authorized Official
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Title or Position | FACILITY DIRECTOR
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Name | MS. CLAUDIA S LOCKWOOD
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Credential | RN
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Telephone | 530-344-1687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 030000767
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License Number State | CA
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