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General NPI Number Information
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NPI Number | 1073753695
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Entity Type | Organization
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Legal Business Name | SUSAN S RANSOME MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/22/2009
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Last Update Date | 02/22/2009
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Provider Practice Location Address
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Address Line | 22225 PACIFIC COAST HWY SUITE 8
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City | MALIBU
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State | CA
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Zip | 90265-4085
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Country | US
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Telephone | 310-456-7477
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Fax |
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Provider Business Mailing Address
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Address Line | 25580 MAYNARD DR
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City | CALABASAS
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State | CA
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Zip | 91302-2223
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Country | US
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Telephone | 818-223-8332
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SUSAN SU SU RANSOME
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Credential | M.D.
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Telephone | 818-223-8332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G77170
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License Number State | CA
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