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General NPI Number Information
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NPI Number | 1104959394
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Entity Type | Individual
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Provider Name | MS. MONICA YVONNE WAYNE
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8485 TAMARIND AVE
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City | FONTANA
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State | CA
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Zip | 92335-3975
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Country | US
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Telephone | 909-428-2366
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Fax | 909-428-2363
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Provider Business Mailing Address
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Address Line | 3925 VAN BUREN BLVD
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City | RIVERSIDE
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State | CA
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Zip | 92503-3620
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Country | US
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Telephone | 951-359-5760
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Fax | 951-359-2024
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 50587
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License Number State | CA
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