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General NPI Number Information
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NPI Number | 1033516943
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Entity Type | Organization
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Legal Business Name | UC REGENTS
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 10833 LE CONTE
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City | LOS ANGELES
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State | CA
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Zip | 90095-1752
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Country | US
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Telephone | 310-825-5904
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Fax | 310-206-8616
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Provider Business Mailing Address
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Address Line | 10833 LE CONTE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90095-1752
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Country | US
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Telephone | 310-825-5904
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Fax | 310-206-8616
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Authorized Official
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Title or Position | EXECUTIVE CHAIR
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Name | DR. SHERIN DEVASKAR
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Credential | M.D..
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Telephone | 310-825-5095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | CA
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