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General NPI Number Information
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NPI Number | 1558613059
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Entity Type | Organization
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Legal Business Name | ST. LUKE MEDICAL CENTER INC.
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 3705 GAGE AVE STE A
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City | BELL
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State | CA
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Zip | 90201-1024
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Country | US
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Telephone | 310-720-2507
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Fax | 310-219-0497
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Provider Business Mailing Address
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Address Line | 3705 GAGE AVE STE A
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City | BELL
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State | CA
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Zip | 90201-1024
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Country | US
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Telephone | 310-720-2507
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Fax | 310-219-0497
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Authorized Official
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Title or Position | MANAGER
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Name | DAISY VARGAS
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Credential |
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Telephone | 310-720-2507
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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 | A34603
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License Number State | CA
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