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General NPI Number Information
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NPI Number | 1336746221
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Entity Type | Organization
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Legal Business Name | AVANGUARD MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 5620 WILBUR AVE STE 207
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City | TARZANA
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State | CA
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Zip | 91356-1309
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Country | US
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Telephone | 818-344-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 5620 WILBUR AVE STE 207
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City | TARZANA
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State | CA
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Zip | 91356-1309
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Country | US
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Telephone | 818-344-0070
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | VICTORIYA TEPMAN
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Credential |
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Telephone | 818-344-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471V0106X
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Taxonomy Name | Vascular-Interventional Technology Radiologic Technologist
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License Number |
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License Number State |
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