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General NPI Number Information
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NPI Number | 1346496056
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Entity Type | Organization
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Legal Business Name | COASTAL FOOT CARE SERVICES, INC
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 3901 LAS POSAS RD SUITE #9
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City | CAMARILLO
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State | CA
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Zip | 93010-1501
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Country | US
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Telephone | 805-531-1089
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Fax | 808-531-5489
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Provider Business Mailing Address
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Address Line | 3901 LAS POSAS RD SUITE #9
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City | CAMARILLO
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State | CA
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Zip | 93010-1501
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Country | US
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Telephone | 805-531-1089
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Fax | 808-531-5489
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Authorized Official
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Title or Position | PREISENT/OWNER
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Name | DR. MITCHELL GLODOWSKI
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Credential | DPM
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Telephone | 805-531-1089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E4616
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4616
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License Number State | CA
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