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General NPI Number Information
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NPI Number | 1346297967
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Entity Type | Individual
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Provider Name | AGNES BUSTAMANTE CONSOLACION PT, CHT
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Gender | Female
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1700 CALIFORNIA ST SUITE 450
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-4586
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Country | US
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Telephone | 415-359-1444
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Fax | 415-447-3868
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Provider Business Mailing Address
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Address Line | 2844 SAN JOSE AVE
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City | ALAMEDA
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State | CA
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Zip | 94501-5461
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Country | US
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Telephone | 510-769-7407
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Fax | 415-447-3868
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 25333
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License Number State | CA
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