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General NPI Number Information
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NPI Number | 1114056769
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Entity Type | Individual
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Provider Name | DIOSDADO L TABILON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7000 FRANKLIN BLVD STE 200
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City | SACRAMENTO
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State | CA
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Zip | 95823-1865
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Country | US
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Telephone | 913-394-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 EUCALYPTUS DRIVE APT 737
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City | AMERICAN CANYON
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State | CA
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Zip | 94503-1177
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Country | US
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Telephone | 510-375-3143
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A35896
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License Number State | CA
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