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General NPI Number Information
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NPI Number | 1306090824
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Entity Type | Organization
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Legal Business Name | LONG BEACH VAMC
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 5901 E 7TH ST
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City | LONG BEACH
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State | CA
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Zip | 90822-5201
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Country | US
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Telephone | 562-826-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 10182 LAMPSON AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92840-4715
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Country | US
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Telephone | 714-530-7283
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Fax |
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Authorized Official
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Title or Position | CERTIFIED RESPIRATORY THERAPIST
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Name | MR. BOBBY GENE WALL
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Credential | CRTT
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Telephone | 562-826-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | DISCONTINUED
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License Number State | CA
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