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General NPI Number Information
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NPI Number | 1487103784
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Entity Type | Organization
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Legal Business Name | ALLIANCE MEDICAL GROUP
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 2323 E 8TH ST STE 103
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2813
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Country | US
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Telephone | 619-512-1600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 390005
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City | SAN DIEGO
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State | CA
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Zip | 92149-0005
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Country | US
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Telephone | 619-512-6200
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | KYLA ESCOBEDO
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Credential |
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Telephone | 619-746-6530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A107847
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License Number State | CA
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