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General NPI Number Information
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NPI Number | 1003887944
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Entity Type | Individual
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Provider Name | ALETA BELINDA GONG O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 16020 N 35TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85053-3822
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Country | US
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Telephone | 602-547-3255
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Fax |
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Provider Business Mailing Address
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Address Line | POST OFFICE BOX 11585
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City | GLENDALE
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State | AZ
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Zip | 85318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | AZ 835
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License Number State | AZ
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