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General NPI Number Information
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NPI Number | 1497781579
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Entity Type | Organization
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Legal Business Name | SAN CRISTOBAL MEDICAL GROUP INC.
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1930 WILSHIRE BLVD SUITE 405
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City | LOS ANGELES
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State | CA
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Zip | 90057-3605
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Country | US
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Telephone | 213-413-1890
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 WILSHIRE BLVD SUITE 410
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City | LOS ANGELES
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State | CA
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Zip | 90057-3605
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Country | US
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Telephone | 213-413-4203
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Fax | 213-413-5615
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMOS CHEERKEY ACOFF
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Credential | M.D.
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Telephone | 213-413-4203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | FNP 24915
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License Number State | CA
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