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General NPI Number Information
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NPI Number | 1174987135
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Entity Type | Organization
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Legal Business Name | SURGICAL TREATMENT AND REGENERATION II, LLC
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 2711 N SEPULVEDA BLVD #223
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-2725
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Country | US
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Telephone | 760-375-3974
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Fax | 760-375-3953
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Provider Business Mailing Address
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Address Line | 120 S SPALDING DR SUITE 200
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-1800
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Country | US
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Telephone | 760-375-3974
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Fax | 760-375-3953
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | NEIL GHODADRA
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Credential | MD
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Telephone | 678-596-1344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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