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General NPI Number Information
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NPI Number | 1306489687
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Entity Type | Organization
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Legal Business Name | JAMES LONGORIA MD INC
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Dates
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Enumeration Date | 10/19/2019
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Last Update Date | 10/19/2019
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Provider Practice Location Address
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Address Line | 2800 L ST STE 200
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City | SACRAMENTO
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State | CA
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Zip | 95816-5616
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Country | US
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Telephone | 916-456-4428
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Fax |
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Provider Business Mailing Address
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Address Line | 2443 FAIR OAKS BLVD # 244
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City | SACRAMENTO
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State | CA
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Zip | 95825-7684
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Country | US
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Telephone | 916-717-0187
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES LONGORIA
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Credential | MD
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Telephone | 916-717-0187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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