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General NPI Number Information
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NPI Number | 1306245519
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Entity Type | Individual
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Provider Name | THAO DINH TOMCZYK PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 341 MAGNOLIA AVE STE 201
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City | CORONA
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State | CA
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Zip | 92879-3332
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Country | US
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Telephone | 951-371-6979
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Fax | 951-371-5830
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Provider Business Mailing Address
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Address Line | 16118 SKYRIDGE DR
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City | RIVERSIDE
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State | CA
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Zip | 92503-5578
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Country | US
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Telephone | 714-624-5753
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 51783
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License Number State | CA
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