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General NPI Number Information
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NPI Number | 1083185748
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Entity Type | Organization
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Legal Business Name | BIOMEDRX INC.
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 04/27/2019
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Provider Practice Location Address
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Address Line | 916 N MOUNTAIN AVE STE D1
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City | UPLAND
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State | CA
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Zip | 91786-3658
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Country | US
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Telephone | 909-608-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 8306 WILSHIRE BLVD STE 777
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2304
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Country | US
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Telephone | 142-420-4238
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DEVIN ANTHONY LOCKETT
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Credential | BMET, CE, CNT, CBPT
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Telephone | 424-204-2382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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