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General NPI Number Information
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NPI Number | 1154642809
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Entity Type | Organization
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Legal Business Name | CIVILLANI D. LAYOS
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 15362 GARFIELD DRIVE
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City | FONTANA
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State | CA
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Zip | 92336
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Country | US
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Telephone | 909-574-6192
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Fax | 909-574-6192
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Provider Business Mailing Address
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Address Line | 15362 GARFIELD DRIVE
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City | FONTANA
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State | CA
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Zip | 92336
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Country | US
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Telephone | 909-574-6192
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Fax | 909-574-6192
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Authorized Official
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Title or Position | OWNER
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Name | CIVILLANI DELA PENA LAYOS
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Credential | PT
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Telephone | 909-574-6192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 28911
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License Number State | CA
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