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NPI 1326426743

NPI 1326426743 : JOSH TAVES LAC : WALNUT CREEK, CA

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General NPI Number Information
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    NPI Number           |    1326426743
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    Entity Type          |    Individual 
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    Provider Name        |    JOSH TAVES LAC
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    05/18/2015
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    Last Update Date     |    09/23/2016
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Provider Practice Location Address
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    Address Line         |    3100 OAK RD STE 120 
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    City                 |    WALNUT CREEK
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    State                |    CA
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    Zip                  |    94597-2039
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    Country              |    US
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    Telephone            |    925-785-7364
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    1269 LINDELL DR 
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    City                 |    WALNUT CREEK
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    State                |    CA
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    Zip                  |    94596-6040
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    Country              |    US
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    Telephone            |    
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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        |    171100000X
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    Taxonomy Name        |    Acupuncturist
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    License Number       |    16474
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    License Number State |    CA
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