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General NPI Number Information
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NPI Number | 1245231174
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Entity Type | Individual
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Provider Name | VALERIE CYNTHIA ALTAVAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 655 EUCLID AVE SUITE 302 304
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2957
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Country | US
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Telephone | 619-472-4575
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Fax | 619-472-4530
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Provider Business Mailing Address
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Address Line | 1440 HOTEL CIR N APT 371
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City | SAN DIEGO
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State | CA
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Zip | 92108-2906
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Country | US
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Telephone | 619-501-9110
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Fax | 619-472-4530
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 201309
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License Number State | NY
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