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General NPI Number Information
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NPI Number | 1154628493
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Entity Type | Organization
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Legal Business Name | CLIFFORD I IRIELE MD INC
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 1711 W TEMPLE ST SUITE 6642
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City | LOS ANGELES
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State | CA
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Zip | 90026-5421
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Country | US
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Telephone | 213-483-0246
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Fax | 213-483-0249
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Provider Business Mailing Address
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Address Line | PO BOX 34819
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City | LOS ANGELES
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State | CA
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Zip | 90034-0819
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Country | US
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Telephone | 213-483-0246
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Fax | 213-483-0249
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Authorized Official
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Title or Position | OWNER
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Name | CLIFFORD IFEANYI IRIELE
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Credential | MD
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Telephone | 213-483-0246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A102130
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License Number State | CA
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