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General NPI Number Information
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NPI Number | 1457628513
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Entity Type | Organization
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Legal Business Name | AMY VANBLARICOM, MD AFC
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 180 NEWPORT CENTER DR 265
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-6972
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Country | US
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Telephone | 949-706-0181
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Fax |
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Provider Business Mailing Address
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Address Line | 180 NEWPORT CENTER DR 265
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-6972
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Country | US
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Telephone | 949-706-0181
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. AMY VANBLARICOM
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Credential | MD
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Telephone | 949-706-0181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C52798
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License Number State | CA
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