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General NPI Number Information
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NPI Number | 1174833149
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Entity Type | Organization
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Legal Business Name | THE MISSION MEDICAL CLINIC OF SANTA ANA, INC.
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 1514 N SYCAMORE ST
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City | SANTA ANA
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State | CA
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Zip | 92701-2332
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Country | US
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Telephone | 714-558-6800
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Fax | 714-558-7600
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Provider Business Mailing Address
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Address Line | 1514 N SYCAMORE ST
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City | SANTA ANA
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State | CA
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Zip | 92701-2332
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Country | US
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Telephone | 714-558-6800
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Fax | 714-558-7600
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. EDUARDO RAUL DI SARLI
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Credential | M.D.
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Telephone | 714-558-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A36991
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License Number State | CA
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