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General NPI Number Information
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NPI Number | 1114376670
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Entity Type | Organization
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Legal Business Name | ABLW LLC
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 27126 PASEO ESPADA SUITE 1627
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2721
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Country | US
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Telephone | 949-313-7443
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Fax |
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Provider Business Mailing Address
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Address Line | 29421 SPOTTED BULL WAY
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1033
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DAVID MUNCE
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Credential |
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Telephone | 714-316-4630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 201534310060
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License Number State | CA
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