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General NPI Number Information
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NPI Number | 1487894457
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Entity Type | Organization
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Legal Business Name | SUSAN GOODLERNER MD INC
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 23451 MADISON ST STE 330
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City | TORRANCE
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State | CA
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Zip | 90505-4762
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Country | US
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Telephone | 310-375-9994
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Fax |
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Provider Business Mailing Address
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Address Line | 23451 MADISON ST STE 330
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City | TORRANCE
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State | CA
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Zip | 90505-4762
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Country | US
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Telephone | 310-375-9994
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN GOODLERNER
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Credential | M.D.
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Telephone | 310-375-9994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G44627
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License Number State | CA
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