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General NPI Number Information
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NPI Number | 1073702643
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Entity Type | Organization
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Legal Business Name | FRED JAMES GALLUCCIO M.D.
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 901 DOVER DR STE 102
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5514
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Country | US
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Telephone | 949-646-4865
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Fax | 949-646-7716
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Provider Business Mailing Address
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Address Line | 901 DOVER DR STE 102
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5514
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Country | US
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Telephone | 949-646-4865
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Fax | 949-646-7716
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Authorized Official
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Title or Position | SECRETARY
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Name | MONIKA M GALLUCCIO
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Credential |
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Telephone | 949-646-4865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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