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General NPI Number Information
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NPI Number | 1528958626
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Entity Type | Organization
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Legal Business Name | ALTA CIELO MEDICAL GROUP INC
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 855 N LARK ELLEN AVE # J1
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City | WEST COVINA
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State | CA
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Zip | 91791-1099
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Country | US
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Telephone | 626-722-4695
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Fax | 626-727-7180
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Provider Business Mailing Address
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Address Line | 855 N LARK ELLEN AVE # J1
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City | WEST COVINA
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State | CA
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Zip | 91791-1099
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Country | US
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Telephone | 626-722-4695
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Fax | 626-727-7180
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Authorized Official
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Title or Position | OWNER
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Name | MS. AGNES DULDULAO
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Credential |
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Telephone | 626-722-4695
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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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