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General NPI Number Information
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NPI Number | 1194670349
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Entity Type | Organization
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Legal Business Name | FOUNTAIN VALLEY GROUP SERVICES PC
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 47111 MONROE ST
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City | INDIO
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State | CA
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Zip | 92201-6739
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Country | US
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Telephone | 760-347-6191
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Fax |
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Provider Business Mailing Address
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Address Line | 5665 NEW NORTHSIDE DR STE 320
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City | ATLANTA
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State | GA
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Zip | 30328-5834
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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 | VP, CREDENTIALING
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Name | KIM H LARSEN
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Credential |
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Telephone | 770-874-5468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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