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General NPI Number Information
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NPI Number | 1225853146
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Entity Type | Individual
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Provider Name | MISAEL GALLEGOS COTA/L
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Gender | Male
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 18270 SISKIYOU RD # B
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City | APPLE VALLEY
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State | CA
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Zip | 92307-1413
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Country | US
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Telephone | 760-991-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 25755 RITTER AVE
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City | HOMELAND
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State | CA
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Zip | 92548-9280
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Country | US
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Telephone | 562-322-2143
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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 | 224ZF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapy Assistant
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License Number | 7004
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License Number State | CA
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