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General NPI Number Information
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NPI Number | 1508299827
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Entity Type | Organization
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Legal Business Name | SAINT LAZARO MEDICAL CENTER INC
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Dates
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Enumeration Date | 08/11/2013
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Last Update Date | 08/11/2013
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Provider Practice Location Address
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Address Line | 11117 S INGLEWOOD AVE SUITE A
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City | LENNOX
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State | CA
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Zip | 90304-2514
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Country | US
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Telephone | 310-673-0658
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Fax |
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Provider Business Mailing Address
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Address Line | 11117 S INGLEWOOD AVE SUITE A
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City | LENNOX
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State | CA
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Zip | 90304-2514
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TECHNICAL MANAGER
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Name | ESTHER EDEM
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Credential |
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Telephone | 310-256-6586
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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 |
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License Number State |
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