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General NPI Number Information
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NPI Number | 1417123597
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Entity Type | Organization
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Legal Business Name | SALIMPOUR PEDIATRIC MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 15253 ROSCOE BLVD
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City | PANORAMA CITY
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State | CA
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Zip | 91402-4401
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Country | US
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Telephone | 818-920-9947
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Fax |
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Provider Business Mailing Address
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Address Line | 15253 ROSCOE BLVD
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City | PANORAMA CITY
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State | CA
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Zip | 91402-4401
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Country | US
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Telephone | 818-920-9947
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | RALPH SALIMPOUR
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Credential | M.D.
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Telephone | 818-907-0322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A36971
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License Number State | CA
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