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General NPI Number Information
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NPI Number | 1124905724
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Entity Type | Individual
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Provider Name | SIMON HANSEN
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Gender | Male
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 804 LIBERTY ST
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City | SANTA MARIA
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State | CA
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Zip | 93458-6806
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Country | US
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Telephone | 805-361-4625
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Fax |
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Provider Business Mailing Address
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Address Line | 3912 CRESTMONT DR
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City | SANTA MARIA
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State | CA
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Zip | 93455-3026
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Country | US
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Telephone | 760-445-7720
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | 2170B30F6C
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License Number State | CA
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