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General NPI Number Information
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NPI Number | 1063887875
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Entity Type | Organization
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Legal Business Name | MAGNOLIA SURGERY CENTER, LLC
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Dates
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Enumeration Date | 12/04/2015
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 463 N MAGNOLIA AVE
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City | EL CAJON
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State | CA
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Zip | 92020-3606
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Country | US
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Telephone | 619-990-1698
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 181770
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City | CORONADO
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State | CA
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Zip | 92178-1770
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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 | PRESIDENT
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Name | TAREK HASSANEIN
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Credential |
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Telephone | 619-990-1698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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