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General NPI Number Information
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NPI Number | 1134156649
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Entity Type | Individual
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Provider Name | RACHELLE JEANNEA DOUGLASS MD
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Gender | Female
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 7901 WALKER ST
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City | LA PALMA
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State | CA
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Zip | 90623-1722
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Country | US
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Telephone | 714-670-6133
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11177
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City | COSTA MESA
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State | CA
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Zip | 92627-1177
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Country | US
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Telephone | 816-289-0533
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A104586
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2008009980
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License Number State | MO
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