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General NPI Number Information
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NPI Number | 1588718522
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Entity Type | Organization
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Legal Business Name | DESERT ROSE OBSTETRICS & GYNECOLOGY
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 01/08/2014
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Provider Practice Location Address
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Address Line | 2170 SOUTH AVE
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150
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Country | US
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Telephone | 775-882-8487
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Fax | 775-882-8487
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Provider Business Mailing Address
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Address Line | P.O. BOX 2046
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City | CARSON CITY
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State | NV
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Zip | 89702
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Country | US
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Telephone | 775-882-8487
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Fax | 775-882-8487
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MATTHEW JOSEPH BARULICH III
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Credential | M.D.
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Telephone | 775-846-5228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 5413
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0116950
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License Number State | NV
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