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General NPI Number Information
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NPI Number | 1568613107
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Entity Type | Organization
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Legal Business Name | J. RAUL SALAS, M.D., INC
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 575 W PUTNAM AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-3270
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Country | US
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Telephone | 559-784-6878
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Fax | 559-784-1592
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Provider Business Mailing Address
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Address Line | 667 W BELLEVIEW AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-2176
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Country | US
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Telephone | 559-310-8729
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE RAUL SALAS SR.
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Credential | M.D.
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Telephone | 559-310-8729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | LAB58497H
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License Number State | CA
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