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General NPI Number Information
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NPI Number | 1093809139
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Entity Type | Organization
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Legal Business Name | PRISMA CARE, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 2648 MAIN ST SUITE #A
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City | CHULA VISTA
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State | CA
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Zip | 91911-4664
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Country | US
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Telephone | 619-575-5000
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Fax | 619-575-5060
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Provider Business Mailing Address
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Address Line | 2648 MAIN ST SUITE #A
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City | CHULA VISTA
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State | CA
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Zip | 91911-4664
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Country | US
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Telephone | 619-575-5000
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Fax | 619-575-5060
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSE R LOPEZ
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Credential |
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Telephone | 619-575-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A43301
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License Number State | CA
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