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General NPI Number Information
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NPI Number | 1174911655
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Entity Type | Individual
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Provider Name | ALLEN VY B.S.
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Gender | Male
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 631 MAPLE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90014-2211
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Country | US
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Telephone | 323-302-2599
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Fax |
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Provider Business Mailing Address
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Address Line | 3611 S HARBOR BLVD STE 100
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City | SANTA ANA
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State | CA
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Zip | 92704-7915
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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