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General NPI Number Information
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NPI Number | 1518372721
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Entity Type | Individual
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Provider Name | CAMILO EMILIO CANO PORTILLO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 6041 CADILLAC AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 323-533-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 12717 MITCHELL AVE APT 5
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City | LOS ANGELES
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State | CA
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Zip | 90066-4745
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Country | US
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Telephone | 312-860-4111
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | A169519
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125065052
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD-45237
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A169519
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD-45237
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License Number State | IA
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