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General NPI Number Information
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NPI Number | 1427284082
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Entity Type | Organization
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Legal Business Name | LAC-USC-MED-CTR
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 1240 N MISSION RD # 919
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City | LOS ANGELES
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State | CA
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Zip | 90033-1019
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Country | US
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Telephone | 323-409-6715
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 N. MISSION RD #919 DEM
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City | LOS ANGELES
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State | CA
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Zip | 90033
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Country | US
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Telephone | 132-340-9761
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR PA
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Name | MRS. CHRISTINE DINUZZO
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Credential | PHYSICIAN ASSISTANT
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Telephone | 13234096715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | PA14057
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License Number State | CA
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