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General NPI Number Information
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NPI Number | 1326726076
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Entity Type | Organization
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Legal Business Name | MINDFIELD MEDICAL
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 6330 SAN VICENTE BLVD STE 510
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City | LOS ANGELES
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State | CA
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Zip | 90048-5455
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Country | US
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Telephone | 310-658-4008
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Fax |
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Provider Business Mailing Address
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Address Line | 1138 S CRESCENT HEIGHTS BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-2635
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Country | US
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Telephone | 310-658-4008
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | EDWARD J BATES
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Credential |
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Telephone | 310-658-4008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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