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General NPI Number Information
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NPI Number | 1609916048
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Entity Type | Organization
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Legal Business Name | INDRAVADAN A DAVE MD INC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 274 ONE AND HALF S RAMPART BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90057-1404
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Country | US
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Telephone | 213-389-5570
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Fax | 213-389-5578
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Provider Business Mailing Address
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Address Line | 274 ONE AND HALF S RAMPART BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90057-1404
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Country | US
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Telephone | 213-389-5570
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Fax | 213-389-5578
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Authorized Official
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Title or Position | OWNER PRES
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Name | DR. INDRAVADAN A DAVE
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Credential | M.D.
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Telephone | 213-389-5570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C41876
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License Number State | CA
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