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General NPI Number Information
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NPI Number | 1487961421
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Entity Type | Organization
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Legal Business Name | PRO OFFICE INC
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Dates
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Enumeration Date | 09/13/2010
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 399 E HIGHLAND AVE 309
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-3808
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Country | US
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Telephone | 909-713-9957
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Fax |
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Provider Business Mailing Address
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Address Line | 1685 MAGNOLIA AVE 227
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City | RIVERSIDE
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State | CA
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Zip | 92506
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Country | US
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Telephone | 909-713-9957
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. NATALYA V SUMINA
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Credential | MD
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Telephone | 909-713-9957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A88502
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License Number State |
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