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General NPI Number Information
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NPI Number | 1134276041
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Entity Type | Individual
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Provider Name | LAURENCE MARION RICK PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 25825 VERMONT AVE KAISER PERMANENTE,LAKESIDE MODULE 5
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City | HARBOR CITY
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State | CA
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Zip | 90710-3518
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Country | US
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Telephone | 310-517-3332
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Fax |
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Provider Business Mailing Address
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Address Line | 2348 LIVE OAK MEADOWS RD
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City | MALIBU
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State | CA
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Zip | 90265-3009
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Country | US
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Telephone | 310-629-3332
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 12425
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License Number State | CA
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