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General NPI Number Information
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NPI Number | 1164560272
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Entity Type | Organization
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Legal Business Name | MED-PRO FAMLIY CLINIC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11017 ATLANTIC AVE
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City | LYNWOOD
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State | CA
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Zip | 90262-3001
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Country | US
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Telephone | 310-635-3800
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Fax | 310-635-5448
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Provider Business Mailing Address
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Address Line | 11017 ATLANTIC AVE
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City | LYNWOOD
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State | CA
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Zip | 90262-3001
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Country | US
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Telephone | 310-635-3800
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Fax | 310-635-5448
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SAYEEDA SULTANA
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Credential | M.D
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Telephone | 310-635-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | A53436
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License Number State | CA
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