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General NPI Number Information
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NPI Number | 1164448593
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Entity Type | Organization
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Legal Business Name | CAL CHOICE FAMILY PRACTICE INC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 16245 DESERT KNOLL DR
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City | VICTORVILLE
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State | CA
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Zip | 92395-4011
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Country | US
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Telephone | 760-955-9555
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Fax | 760-955-8558
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Provider Business Mailing Address
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Address Line | PO BOX 1596
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City | VICTORVILLE
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State | CA
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Zip | 92393-1596
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Country | US
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Telephone | 760-955-9555
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Fax | 760-955-8558
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MELISSA GRAHAM
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Credential |
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Telephone | 760-955-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A87666
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License Number State | CA
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