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General NPI Number Information
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NPI Number | 1174764351
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Entity Type | Organization
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Legal Business Name | CLINICA LOS REMEDIOS MEDICAL GROUP
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 2400 W 7TH ST STE 114
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City | LOS ANGELES
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State | CA
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Zip | 90057-5008
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Country | US
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Telephone | 213-389-9595
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Fax | 213-389-2556
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Provider Business Mailing Address
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Address Line | 2400 W 7TH ST STE 114
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City | LOS ANGELES
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State | CA
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Zip | 90057-5008
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Country | US
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Telephone | 213-389-9595
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Fax | 213-389-2556
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAYNALDO LIMPIN MAKABALI
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Credential | M.D.
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Telephone | 213-389-9595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A51157
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A51157
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License Number State | CA
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