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General NPI Number Information
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NPI Number | 1417329947
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Entity Type | Individual
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Provider Name | SUJA SAMUEL
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Gender | Female
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 10/23/2015
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Provider Practice Location Address
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Address Line | 597 CENTER AVENUE, SUITE 200-A
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City | MARTINEZ
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State | CA
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Zip | 94553
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Country | US
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Telephone | 925-313-6740
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Fax |
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Provider Business Mailing Address
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Address Line | P.O.BOX 4738
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City | ANTIOCH
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State | CA
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Zip | 94531
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Country | US
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Telephone | 405-436-3557
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 666581
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License Number State | CA
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