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General NPI Number Information
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NPI Number | 1275843740
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Entity Type | Organization
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Legal Business Name | PUGET SOUND BLOOD CENTER
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 921 TERRY AVE
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City | SEATTLE
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State | WA
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Zip | 98104
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Country | US
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Telephone | 818-448-5692
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Fax |
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Provider Business Mailing Address
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Address Line | 1626 N WILCOX AVE STE 183
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City | HOLLYWOOD
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State | CA
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Zip | 90028
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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 | VICENTE CASTANON
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Credential |
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Telephone | 818-448-5692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 50D0661429
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License Number State | WA
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