| El Dorado-palmdale | |
|
2720 E Palmdale Blvd Ste 129-131 Palmdale CA 93550-4930 | |
| (661) 947-3333 | |
| (661) 575-2397 |
| Full Name | El Dorado-palmdale |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2720 E Palmdale Blvd Ste 129-131, Palmdale, California |
| Authorized Official Name and Position | Manuel Tapia (BILLING SPECIALIST) |
| Authorized Official Contact | 6612546630 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| El Dorado-palmdale Po Box 801809 Valencia CA 91380-1809 Ph: (661) 254-6630 | El Dorado-palmdale 2720 E Palmdale Blvd Ste 129-131 Palmdale CA 93550-4930 Ph: (661) 947-3333 |
| NPI Number | 1568531036 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 09/24/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568531036 | NPI | - | NPPES |
| 6905 | Medicaid | CA | |
| HDC70053F | Medicaid | CA | |
| CMM70729F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 960001031 (California) | Primary |
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