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General NPI Number Information
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NPI Number | 1467805325
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Entity Type | Organization
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Legal Business Name | EVISH KAMRAVA MD PC
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 32144 AGOURA RD STE 200
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-4031
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Country | US
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Telephone | 805-601-7772
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Fax | 805-601-7773
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Provider Business Mailing Address
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Address Line | PO BOX 3129
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City | TORRANCE
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State | CA
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Zip | 90510-3129
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Authorized Official
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Title or Position | PRESIDENT
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Name | EVISH KAMRAVA
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Credential | MD
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Telephone | 805-601-7772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A125995
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License Number State | CA
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