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General NPI Number Information
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NPI Number | 1407241359
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Entity Type | Organization
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Legal Business Name | EXODUS
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 1685 N HOMSY AVE
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City | CLOVIS
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State | CA
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Zip | 93619-3725
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Country | US
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Telephone | 559-246-1963
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Fax |
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Provider Business Mailing Address
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Address Line | 1685 N HOMSY AVE
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City | CLOVIS
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State | CA
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Zip | 93619-3725
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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 | RN
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Name | JULIA C ARMAS
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Credential |
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Telephone | 559-246-1963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 163WPO808X
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License Number State | CA
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