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General NPI Number Information
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NPI Number | 1073884474
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Entity Type | Organization
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Legal Business Name | DR ALIREZA PESSARAN MD INC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 6437 FAIR OAKS BLVD
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City | CARMICHAEL
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State | CA
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Zip | 95608-4021
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Country | US
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Telephone | 916-489-3641
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Fax | 916-489-2770
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Provider Business Mailing Address
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Address Line | 6437 FAIR OAKS BLVD
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City | CARMICHAEL
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State | CA
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Zip | 95608-4021
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Country | US
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Telephone | 916-489-3641
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Fax | 916-489-2770
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALIREZA PESSARAN
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Credential | M.D.
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Telephone | 916-489-3641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | GNB32009-43470
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License Number State | CA
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