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General NPI Number Information
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NPI Number | 1114602075
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Entity Type | Individual
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Provider Name | DESTINY RAE RAZO
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Gender | Female
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 40 W G ST
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City | LOS BANOS
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State | CA
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Zip | 93635-3657
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Country | US
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Telephone | 209-381-6800
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Fax | 209-725-3963
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Provider Business Mailing Address
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Address Line | 545 M ST
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City | LOS BANOS
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State | CA
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Zip | 93635-4234
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Country | US
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Telephone | 209-752-4823
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State | CA
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