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General NPI Number Information
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NPI Number | 1215238399
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Entity Type | Organization
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Legal Business Name | MYOFASCIAL HEALTH CENTER OF LA JOLLA
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 7450 GIRARD AVE
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City | LA JOLLA
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State | CA
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Zip | 92037-5142
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Country | US
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Telephone | 858-454-9769
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Fax | 858-454-0384
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Provider Business Mailing Address
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Address Line | 7450 GIRARD AVE LA JOLLA
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City | LA JOLLA
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State | CA
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Zip | 92037-5142
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Country | US
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Telephone | 858-454-9769
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Fax | 858-454-0384
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AUDRA MOORE
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Credential |
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Telephone | 858-454-9769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2877502
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License Number State | CA
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