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General NPI Number Information
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NPI Number | 1013108752
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Entity Type | Organization
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Legal Business Name | MEDICOS UNIDOS DE AVENAL
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 148 E KINGS ST
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City | AVENAL
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State | CA
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Zip | 93204-1529
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Country | US
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Telephone | 559-386-9000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 530
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City | LEMOORE
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State | CA
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Zip | 93245-0530
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Country | US
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Telephone | 559-386-9000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TOMAS BALLESTEROS RIOS
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Credential | M.D.
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Telephone | 559-386-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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