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General NPI Number Information
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NPI Number | 1366640096
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Entity Type | Organization
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Legal Business Name | ANDRE ANDRESIAN,M.D., F.A.C.C.
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 420 N 4TH AVE
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City | COVINA
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State | CA
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Zip | 91723-1835
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Country | US
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Telephone | 626-331-6663
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Fax | 626-339-8132
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Provider Business Mailing Address
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Address Line | 420 N 4TH AVE
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City | COVINA
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State | CA
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Zip | 91723-1835
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Country | US
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Telephone | 626-331-6663
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Fax | 626-339-8132
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Authorized Official
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Title or Position | RN
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Name | MS. SUSANNE ANDRESIAN
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Credential |
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Telephone | 626-331-6663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A25075
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License Number State | CA
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