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General NPI Number Information
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NPI Number | 1164930707
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Entity Type | Organization
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Legal Business Name | CALIFORNIA SPECIALTY HOSPITAL SOUTH
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 21530 PIONEER BLVD
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City | HAWAIIAN GARDENS
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State | CA
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Zip | 90716
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Country | US
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Telephone | 209-505-7464
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Fax |
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Provider Business Mailing Address
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Address Line | 4120 DALE RD # J8-202
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City | MODESTO
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State | CA
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Zip | 95356-9232
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MATTHEW SALAS
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Credential |
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Telephone | 209-505-7464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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