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General NPI Number Information
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NPI Number | 1275719403
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Entity Type | Individual
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Provider Name | JESSICA A RAYHANABAD M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2008
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 3791 KATELLA AVE STE 201
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2016
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Country | US
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Telephone | 562-206-1312
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Fax | 562-206-1314
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Provider Business Mailing Address
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Address Line | 12340 SEAL BEACH BLVD STE B421
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City | SEAL BEACH
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State | CA
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Zip | 90740-2792
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Country | US
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Telephone | 562-206-1312
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Fax | 562-206-1314
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 99470
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A99470
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License Number State | CA
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