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General NPI Number Information
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NPI Number | 1558317032
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Entity Type | Individual
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Provider Name | LARA K KULCHYCKI M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 250 BON AIR RD
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City | GREENBRAE
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State | CA
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Zip | 94904-1702
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Country | US
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Telephone | 415-925-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 CUMMINS DR STE D
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City | MODESTO
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State | CA
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Zip | 95358-6411
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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 |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 227828
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | C54499
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License Number State | CA
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