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General NPI Number Information
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NPI Number | 1164600896
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Entity Type | Organization
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Legal Business Name | MOUTAZ ALMAWALDI MD PC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5120 HILL RD E
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City | LAKEPORT
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State | CA
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Zip | 95453-6300
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Country | US
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Telephone | 707-263-4766
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Fax | 707-263-4771
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Provider Business Mailing Address
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Address Line | 5120 HILL RD E PO BOX 1917
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City | LAKEPORT
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State | CA
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Zip | 95453-6300
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Country | US
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Telephone | 707-263-4766
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Fax | 707-263-4771
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. MOHAMAD MOUTAZ ALMAWALDI
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Credential | M.D.
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Telephone | 707-263-4766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A49796
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License Number State | CA
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