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General NPI Number Information
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NPI Number | 1194871137
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE HEALTH CENTERS
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 1241 W 17TH ST SUITE 1
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City | SANTA ANA
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State | CA
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Zip | 92706-3459
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Country | US
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Telephone | 714-285-9811
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Fax | 714-285-9822
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Provider Business Mailing Address
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Address Line | 8041 NEWMAN AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-7034
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Country | US
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Telephone | 714-500-0200
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Fax | 714-842-0716
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Authorized Official
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Title or Position | CFO
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Name | TRACEY K GOULD
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Credential |
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Telephone | 714-500-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 550000166
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License Number State | CA
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