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General NPI Number Information
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NPI Number | 1609288133
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Entity Type | Organization
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Legal Business Name | MADDIGRL LLC
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 2880 WANEK RD
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City | ESCONDIDO
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State | CA
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Zip | 92027-2889
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Country | US
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Telephone | 760-781-1027
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Fax | 888-588-0942
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Provider Business Mailing Address
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Address Line | 1248 ATWATER ST
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City | CHULA VISTA
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State | CA
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Zip | 91913-1453
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Country | US
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Telephone | 619-934-7884
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Fax | 888-588-0942
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TEOFILO POSADAS MENDOZA JR.
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Credential |
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Telephone | 619-934-7884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number | 374603045
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 374603045
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License Number State | CA
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