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General NPI Number Information
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NPI Number | 1336626639
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Entity Type | Individual
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Provider Name | GABRIELLE ERIN GAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 14550 W SOLEDAD CANYON ROAD
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City | CANYON COUNTRY
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State | CA
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Zip | 91387-2200
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Country | US
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Telephone | 661-250-5220
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Fax | 661-250-5285
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Provider Business Mailing Address
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Address Line | PO BOX 9602
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City | MISSION HILLS
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State | CA
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Zip | 91346-9602
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Country | US
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Telephone | 818-837-5559
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Fax | 818-792-4793
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT33973
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License Number State | CA
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