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General NPI Number Information
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NPI Number | 1245351014
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Entity Type | Organization
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Legal Business Name | ALBERTO CHAVIRA M D A MEDICAL CORP
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 334 VIA VERA CRUZ SUITE 257
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City | SAN MARCOS
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State | CA
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Zip | 92078-2635
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Country | US
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Telephone | 760-510-1808
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Fax | 760-510-1811
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Provider Business Mailing Address
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Address Line | 334 VIA VERA CRUZ SUITE 257
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City | SAN MARCOS
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State | CA
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Zip | 92078-2635
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Country | US
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Telephone | 760-510-1808
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Fax | 760-510-1811
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALBERTO CHAVIRA
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Credential | MD
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Telephone | 760-510-1808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G50302
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License Number State | CA
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