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General NPI Number Information
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NPI Number | 1508172792
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Entity Type | Individual
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Provider Name | ERNESTO MALDONADO
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Gender | Male
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 01/11/2017
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Provider Practice Location Address
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Address Line | 5201 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90037-3527
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Country | US
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Telephone | 310-200-7516
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Fax |
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Provider Business Mailing Address
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Address Line | 6462 ADOBE CIR
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City | IRVINE
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State | CA
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Zip | 92617-5137
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Country | US
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Telephone | 714-337-2041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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