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General NPI Number Information
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NPI Number | 1386270916
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA SPECIALTY CARE, LLC
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Dates
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Enumeration Date | 03/16/2020
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 14900 IMPERIAL HWY
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City | LA MIRADA
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State | CA
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Zip | 90638-2172
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Country | US
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Telephone | 562-944-1900
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Fax | 562-777-3600
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Provider Business Mailing Address
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Address Line | 14900 IMPERIAL HWY
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City | LA MIRADA
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State | CA
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Zip | 90638-2172
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Country | US
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Telephone | 562-944-1900
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Fax | 562-777-3600
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL / SECRETARY
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Name | TERRANCE DILLON
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Credential |
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Telephone | 502-596-7220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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