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General NPI Number Information
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NPI Number | 1386013019
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Entity Type | Organization
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Legal Business Name | RAY MUN LOO MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 385 W MAIN ST
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City | EL CENTRO
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State | CA
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Zip | 92243-3040
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Country | US
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Telephone | 760-355-8817
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1014
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City | EL CENTRO
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State | CA
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Zip | 92244-1014
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Country | US
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Telephone | 760-355-8817
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Fax |
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Authorized Official
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Title or Position | MD
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Name | RAY MUN LOO I
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Credential | M.D
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Telephone | 760-355-8817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A101118
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License Number State | CA
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