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General NPI Number Information
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NPI Number | 1497993562
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Entity Type | Organization
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Legal Business Name | A. ETEMADI MD, INC.
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 02/09/2010
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Provider Practice Location Address
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Address Line | 24881 ALICIA PKWY STE N
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-4617
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Country | US
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Telephone | 949-510-2259
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Fax | 949-388-3336
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Provider Business Mailing Address
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Address Line | 24881 ALICIA PKWY STE N
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-4617
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Country | US
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Telephone | 949-510-2259
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Fax | 949-388-3336
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SHAHNAZ LEWIS
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Credential |
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Telephone | 949-495-1416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G67093
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License Number State | CA
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