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General NPI Number Information
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NPI Number | 1447444690
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Entity Type | Organization
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Legal Business Name | ACLA DERMATOLOGY & MEDICAL CLINIC
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 3701 STOCKER ST SUITE 105
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City | LOS ANGELES
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State | CA
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Zip | 90008-5108
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Country | US
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Telephone | 323-295-0644
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Fax | 323-295-3786
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Provider Business Mailing Address
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Address Line | PO BOX 48618 105
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City | LOS ANGELES
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State | CA
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Zip | 90048-0618
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Country | US
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Telephone | 323-295-0644
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Fax | 323-295-3786
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHEILA CAMPBELL
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Credential |
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Telephone | 323-295-0644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C30645
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License Number State | CA
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