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General NPI Number Information
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NPI Number | 1417007089
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Entity Type | Individual
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Provider Name | MAHNAZ BROUKHIM MD
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 3160 GENEVA ST
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City | LOS ANGELES
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State | CA
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Zip | 90020-1117
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Country | US
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Telephone | 213-368-3338
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Fax | 213-368-3314
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Provider Business Mailing Address
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Address Line | 6430 W SUNSET BLVD SUITE 600
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City | LOS ANGELES
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State | CA
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Zip | 90028-7901
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Country | US
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Telephone | 323-361-2337
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Fax | 323-361-8491
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A80576
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License Number State | CA
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