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General NPI Number Information
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NPI Number | 1417579129
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Entity Type | Organization
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Legal Business Name | CENTRAL CALIFORNIA LEG, FOOT, AND ANKLE CENTER, INC.
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 27462 PORTOLA PKWY STE 100
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City | LAKE FOREST
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State | CA
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Zip | 92610-2838
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Country | US
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Telephone | 949-468-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 217 REGAL
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City | IRVINE
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State | CA
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Zip | 92620-3542
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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 | PRESIDENT
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Name | DR. ALI GHORBANIFARAJZADEH
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Credential | DPM
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Telephone | 305-310-8155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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