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General NPI Number Information
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NPI Number | 1245343128
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Entity Type | Organization
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Legal Business Name | PETER RO, MD, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2309 ANTONIO AVE
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City | CAMARILLO
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State | CA
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Zip | 93010-1414
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Country | US
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Telephone | 805-389-5944
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34
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City | SOMIS
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State | CA
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Zip | 93066-0034
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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 | CEO
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Name | DR. PETER RO
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Credential |
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Telephone | 805-383-8808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | A66723
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License Number State | CA
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