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General NPI Number Information
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NPI Number | 1265646699
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE MEDICAL SERVICES
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 1300 AVENIDA VISTA HERMOSA SUITE 220
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6315
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Country | US
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Telephone | 949-366-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 AVENIDA VISTA HERMOSA SUITE 220
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6315
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Country | US
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Telephone | 949-366-0070
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TORSTEN J KRUSE
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Credential | M.D.
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Telephone | 949-366-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | A75928
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License Number State | CA
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