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General NPI Number Information
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NPI Number | 1558483487
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Entity Type | Individual
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Provider Name | SHAHLA MANSOURI FNP.,MSN.,MPH.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | UNIVERSITY OF CALIFORNIA CAMPUS HEALTH CENTER
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City | RIVERSIDE
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State | CA
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Zip | 92521-0001
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Country | US
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Telephone | 951-827-7186
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Fax | 951-827-3133
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Provider Business Mailing Address
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Address Line | 293 NEWELL DR
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City | RIVERSIDE
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State | CA
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Zip | 92507-3106
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Country | US
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Telephone | 951-686-6998
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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 | 240374
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License Number State | CA
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