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General NPI Number Information
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NPI Number | 1295158335
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Entity Type | Organization
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Legal Business Name | MEDI-EXCEL
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Dates
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Enumeration Date | 01/25/2014
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Last Update Date | 01/25/2014
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Provider Practice Location Address
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Address Line | 750 MEDICAL CENTER CT SUITE 2
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City | CHULA VISTA
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State | CA
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Zip | 91911-6634
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Country | US
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Telephone | 619-421-1659
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Fax |
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Provider Business Mailing Address
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Address Line | 750 MEDICAL CENTER CT SUITE 2
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City | CHULA VISTA
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State | CA
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Zip | 91911-6634
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Country | US
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Telephone | 619-421-1659
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. JIM ARRIOLA
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Credential |
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Telephone | 619-421-1659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 9330486
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License Number State | CA
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