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General NPI Number Information
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NPI Number | 1396951968
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Entity Type | Organization
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Legal Business Name | OSTEOPOROSIS CENTER OF IRVINE
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 26302 LA PAZ RD SUITE 206
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City | MISSION VIEJO
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State | CA
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Zip | 92691-5328
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Country | US
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Telephone | 949-829-9756
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Fax | 949-829-9185
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Provider Business Mailing Address
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Address Line | 26302 LA PAZ RD SUITE 206
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City | MISSION VIEJO
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State | CA
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Zip | 92691-5328
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Country | US
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Telephone | 949-829-9756
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Fax | 949-829-9185
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. SUE A BEARD
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Credential | BS,CNMT,CDT
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Telephone | 949-829-9756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | C040332
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License Number State | CA
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