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General NPI Number Information
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NPI Number | 1528273570
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Entity Type | Organization
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Legal Business Name | MIDORI NISHIMURA M D IBCLC FAMILY MEDICINE AND LACTATION INC
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Dates
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Enumeration Date | 05/12/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 1704 MIRAMONTE AVE SUITE 3
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-3766
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Country | US
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Telephone | 650-996-1943
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Fax | 408-283-2563
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Provider Business Mailing Address
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Address Line | 1704 MIRAMONTE AVE SUITE 3
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-3766
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Country | US
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Telephone | 650-996-1943
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Fax | 408-283-2563
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Authorized Official
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Title or Position | CONSULTANT
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Name | FRANK J PONTERIO
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Credential |
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Telephone | 650-341-6240
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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 | A61183
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License Number State | CA
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