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General NPI Number Information
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NPI Number | 1104011154
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Entity Type | Organization
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Legal Business Name | EDMUNDO R. RUBIO MD INC.
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 16660 PARAMOUNT BLVD SUITE 205
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City | PARAMOUNT
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State | CA
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Zip | 90723-5433
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Country | US
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Telephone | 562-531-3133
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Fax | 562-531-3204
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Provider Business Mailing Address
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Address Line | 16660 PARAMOUNT BLVD SUITE 205
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City | PARAMOUNT
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State | CA
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Zip | 90723-5433
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Country | US
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Telephone | 562-531-3133
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Fax | 562-531-3204
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. EDMUNDO RICAFRENTE RUBIO
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Credential | MD
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Telephone | 562-531-3133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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