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General NPI Number Information
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NPI Number | 1265124176
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Entity Type | Organization
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Legal Business Name | SOCAL SCOLIOSIS CARE
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 16430 VENTURA BLVD STE 108
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City | ENCINO
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State | CA
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Zip | 91436-2135
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Country | US
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Telephone | 818-428-5218
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Fax |
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Provider Business Mailing Address
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Address Line | 9557 HARVEST VISTA DR
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5732
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Country | US
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Telephone | 650-714-3877
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Fax |
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Authorized Official
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Title or Position | CERTIFIED ORTHOTIST
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Name | RAY DIAZ
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Credential | CO
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Telephone | 818-428-5218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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