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General NPI Number Information
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NPI Number | 1326401985
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Entity Type | Organization
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Legal Business Name | EVEREST MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 04/10/2016
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Provider Practice Location Address
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Address Line | 5400 BALBOA BLVD STE 331
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City | ENCINO
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State | CA
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Zip | 91316-5225
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Country | US
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Telephone | 818-849-6777
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Fax | 818-858-1138
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Provider Business Mailing Address
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Address Line | 5400 BALBOA BLVD STE 331
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City | ENCINO
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State | CA
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Zip | 91316-5225
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Country | US
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Telephone | 818-849-6777
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Fax | 818-858-1138
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | ALEX EDWIN EVEREST
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Credential | PHD
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Telephone | 818-849-6777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | G42307
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License Number State | CA
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