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General NPI Number Information
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NPI Number | 1295345452
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Entity Type | Organization
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Legal Business Name | HIGH PERFORMANCE MEDICINE
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 4895 CAPITOLA RD
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City | CAPITOLA
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State | CA
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Zip | 95010-3810
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Country | US
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Telephone | 831-318-0584
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Fax |
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Provider Business Mailing Address
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Address Line | 295 MOON MEADOW LN
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City | FELTON
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State | CA
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Zip | 95018-9442
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Country | US
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Telephone | 831-334-8993
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAT BROOKE
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Credential | L.AC.
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Telephone | 831-334-8993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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