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General NPI Number Information
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NPI Number | 1508200601
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Entity Type | Individual
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Provider Name | M JULIE PATINO
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Gender | Female
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 1330 LINCOLN AVE STE 201
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2142
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Country | US
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Telephone | 415-459-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 LAUREL ST APT 2
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City | MENLO PARK
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State | CA
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Zip | 94025-3341
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Country | US
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Telephone | 415-637-3213
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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