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General NPI Number Information
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NPI Number | 1447734249
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Entity Type | Organization
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Legal Business Name | MOBILE VASCULAR RESOURCE INC.
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 7345 TOPANGA CANYON BLVD STE 130
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City | CANOGA PARK
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State | CA
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Zip | 91303-1244
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Country | US
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Telephone | 562-470-6884
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Fax | 888-646-5861
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Provider Business Mailing Address
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Address Line | 3300 E SOUTH ST # 301A
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City | LAKEWOOD
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State | CA
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Zip | 90805-4549
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Country | US
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Telephone | 562-470-6884
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Fax | 562-616-6619
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Authorized Official
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Title or Position | OWNER
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Name | DR. WINIFRED WILLIAMS
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Credential | MD
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Telephone | 323-434-0434
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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