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General NPI Number Information
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NPI Number | 1154669349
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Entity Type | Organization
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Legal Business Name | GENESIS REHAB
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 430 WILLOW ST
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City | ALAMEDA
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State | CA
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Zip | 94501-6130
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Country | US
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Telephone | 323-481-7865
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Fax |
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Provider Business Mailing Address
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Address Line | 975 EVERETT ST APT 3
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City | LOS ANGELES
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State | CA
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Zip | 90026-4437
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Country | US
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Telephone | 323-481-7865
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Fax |
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Authorized Official
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Title or Position | PTA
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Name | MISS SAVOEUN OUCH
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Credential |
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Telephone | 323-481-7865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | AT9533
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License Number State | CA
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