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General NPI Number Information
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NPI Number | 1083047955
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Entity Type | Organization
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Legal Business Name | WAVE IMAGING, LLC
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 4050 BARRANCA PKWY SUITE 160
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City | IRVINE
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State | CA
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Zip | 92604-7706
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Country | US
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Telephone | 949-726-9500
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Fax | 949-451-1724
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Provider Business Mailing Address
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Address Line | 17360 BROOKHURST ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3720
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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 | MANAGER
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Name | MARK D SCHAFER
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Credential | MD
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Telephone | 657-241-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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