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General NPI Number Information
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NPI Number | 1518019058
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Entity Type | Individual
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Provider Name | PAMELA WONG R.N.N.P.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 25975 NORMANDIE AVE
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City | HARBOR CITY
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State | CA
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Zip | 90710-3416
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Country | US
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Telephone | 310-517-4413
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Fax |
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Provider Business Mailing Address
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Address Line | 26547 DEEPBROOK DR
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-2468
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Country | US
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Telephone | 310-265-7492
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 314209
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License Number State | CA
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