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General NPI Number Information
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NPI Number | 1073261806
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Entity Type | Individual
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Provider Name | MACHARA LYNETTE HOGUE CMT
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Gender | Female
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 3756 SANTA ROSALIA DR
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City | LOS ANGELES
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State | CA
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Zip | 90008-3606
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Country | US
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Telephone | 562-774-3373
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Fax | 855-978-1718
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Provider Business Mailing Address
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Address Line | 24414 MARIGOLD AVE
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City | HARBOR CITY
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State | CA
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Zip | 90710-1827
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Country | US
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Telephone | 310-872-7216
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Fax | 855-978-1718
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 80028
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License Number State | CA
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