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General NPI Number Information
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NPI Number | 1285709725
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Entity Type | Individual
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Provider Name | POPAK FIROOZNAM
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Gender | Female
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 1770 N ORANGE GROVE AVE SUITE 101
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City | POMONA
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State | CA
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Zip | 91767-3027
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Country | US
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Telephone | 909-469-9494
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Fax | 909-865-2982
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Provider Business Mailing Address
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Address Line | 8636 E CANYON VISTA DR
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City | ANAHEIM
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State | CA
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Zip | 92808-1620
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Country | US
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Telephone | 909-469-9494
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A102037
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License Number State | CA
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