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General NPI Number Information
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NPI Number | 1043977655
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Entity Type | Organization
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Legal Business Name | PACIFIC CREST HEALTHCARE INDEPENDENT PROVIDER ASSOCIATION, INC.
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 2601 AIRPORT DR STE 250
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City | TORRANCE
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State | CA
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Zip | 90505-6141
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Country | US
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Telephone | 833-724-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 AIRPORT DR STE 250
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City | TORRANCE
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State | CA
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Zip | 90505-6141
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Country | US
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Telephone | 833-724-4111
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. ROD AMIRI
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Credential | MD
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Telephone | 833-724-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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