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General NPI Number Information
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NPI Number | 1407357882
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Entity Type | Individual
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Provider Name | KATHERINE DELA CRUZ
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Gender | Female
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 5776 STONERIDGE MALL RD STE 340
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City | PLEASANTON
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State | CA
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Zip | 94588-4514
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Country | US
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Telephone | 925-223-8047
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Fax |
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Provider Business Mailing Address
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Address Line | 466 W BONAVENTURE AVE
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City | MOUNTAIN HOUSE
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State | CA
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Zip | 95391-1224
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Country | US
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Telephone | 510-676-2853
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Fax |
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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 |
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