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NPI Code Detail

MEDICARE: EL DORADO UNION SCHOOL DISTRICT

MEDICARE: EL DORADO UNION SCHOOL DISTRICT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251300000XLocal Education Agency (LEA)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10961853OTHERCAMEDICAL

General Provider Information

NPI Number : 1053477273
Entity Type Code : Organization
Provider Name (Legal Business Name) : EL DORADO UNION SCHOOL DISTRICT
Provider Business Mailing Address
First Line : 2777 DEL MONTE ST
Second Line :
City : WEST SACRAMENTO
State : CA
Zip : 95691-3811
Country : US
Telephone Number : 916-375-1707
Fax Number :
Provider Business Practice Location Address
First Line : 4675 MISSOURI FLAT RD
Second Line :
City : PLACERVILLE
State : CA
Zip : 95667-6816
Country : US
Telephone Number : 530-622-5081
Fax Number :
Authorized Official
Title or Position : SUPERINTENDENT
Name : SHERRY J SMITH
Credential :
Telephone Number : 530-622-5081
Provider Enumeration Date : 12/29/2006
Last Update Date : 08/22/2020

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Directions to “EL DORADO UNION SCHOOL DISTRICT ” Practice Location

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