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General NPI Number Information
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NPI Number | 1003503137
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Entity Type | Organization
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Legal Business Name | PRO-LIFE IMAGING LLC
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Dates
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Enumeration Date | 04/19/2023
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 3411 JOHNSTON AVE
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City | REDONDO BEACH
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State | CA
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Zip | 90278-1522
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Country | US
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Telephone | 661-713-8720
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Fax | 855-940-1565
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Provider Business Mailing Address
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Address Line | 5450 N PARAMOUNT BLVD UNIT 133
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City | LONG BEACH
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State | CA
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Zip | 90805
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Country | US
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Telephone | 661-713-8720
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Fax | 855-940-1565
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Authorized Official
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Title or Position | CEO
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Name | GRISELDA M LOUGEDO
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Credential | CRT
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Telephone | 661-713-8720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0207X
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Taxonomy Name | Mobile Mammography Clinic/Center
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License Number |
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License Number State |
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