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General NPI Number Information
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NPI Number | 1376893784
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Entity Type | Organization
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Legal Business Name | SAN JOAQUIN VALLEY SURGERY CENTER
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 1524 MCHENRY AVE STE 240
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City | MODESTO
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State | CA
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Zip | 95350-4566
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Country | US
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Telephone | 888-942-9997
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Fax |
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Provider Business Mailing Address
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Address Line | 269 S BEVERLY DR STE 353
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-3851
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSISTANT MANAGER
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Name | MS. MONICA PORTER
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Credential |
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Telephone | 888-942-9997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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