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General NPI Number Information
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NPI Number | 1134415664
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Entity Type | Individual
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Provider Name | MICHAEL R. MIJARES M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 6815 NOBLE AVE
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City | VAN NUYS
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State | CA
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Zip | 91405-3796
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Country | US
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Telephone | 818-901-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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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 |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A167633
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | A167633
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | FL
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