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General NPI Number Information
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NPI Number | 1366237893
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Entity Type | Organization
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Legal Business Name | ELEPHANT HEAD LLC
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 337 W FELICITA AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-6515
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Country | US
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Telephone | 866-712-5655
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Fax |
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Provider Business Mailing Address
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Address Line | 27629 HERITAGE LN
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City | VALLEY CENTER
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State | CA
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Zip | 92082-6959
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Country | US
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Telephone | 858-888-5214
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RITESH MHATRE
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Credential |
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Telephone | 858-888-5214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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