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General NPI Number Information
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NPI Number | 1558950022
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Entity Type | Organization
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Legal Business Name | INTEGRATED HOME DIALYSIS STAFF ASSISTANT LLC
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 1507 ROSS ST
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City | POMONA
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State | CA
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Zip | 91767-4246
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Country | US
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Telephone | 310-614-8740
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 76016
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City | LOS ANGELES
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State | CA
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Zip | 90076-0016
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Country | US
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Telephone | 310-614-8740
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. SAM O OBEMBE
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Credential |
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Telephone | 310-614-8740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2472R0900X
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Taxonomy Name | Renal Dialysis Technician
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License Number |
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License Number State |
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