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General NPI Number Information
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NPI Number | 1609118983
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Entity Type | Organization
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Legal Business Name | SALAM F ALKASSPOOLES M D AMC
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 11633 SAN VICENTE BLVD SUITE 314
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City | LOS ANGELES
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State | CA
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Zip | 90049-6511
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Country | US
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Telephone | 310-207-0020
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Fax | 310-207-0030
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Provider Business Mailing Address
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Address Line | 11633 SAN VICENTE BLVD STE 314
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City | LOS ANGELES
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State | CA
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Zip | 90049-6514
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Country | US
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Telephone | 310-207-0020
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Fax | 310-207-0030
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SALAM F ALKASSPOOLES
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Credential | M.D.
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Telephone | 310-652-0092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | CA
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