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General NPI Number Information
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NPI Number | 1396556783
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Entity Type | Individual
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Provider Name | BENJAMIN RUIZ VILLALPANDO
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Gender | Male
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 10563 MILLS AVE
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City | MONTCLAIR
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State | CA
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Zip | 91763-4610
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Country | US
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Telephone | 909-626-4020
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Fax | 909-839-6051
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Provider Business Mailing Address
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Address Line | 15207 CRAZY HORSE AVE
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City | FONTANA
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State | CA
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Zip | 92336-5321
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Country | US
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Telephone | 909-240-3815
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Fax | 909-839-6051
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | CA
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