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General NPI Number Information
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NPI Number | 1063406528
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Entity Type | Individual
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Provider Name | GRETCHEN D SAMPSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 15031 RINALDI ST DEPT OF PATHOLOGY
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City | MISSION HILLS
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State | CA
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Zip | 91345-1207
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Country | US
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Telephone | 818-898-4412
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Fax | 818-898-4419
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Provider Business Mailing Address
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Address Line | 2219 W OLIVE AVE #219
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City | BURBANK
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State | CA
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Zip | 91506-2625
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Country | US
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Telephone | 818-898-4412
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Fax | 818-898-4419
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | G44040
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License Number State | CA
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