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General NPI Number Information
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NPI Number | 1609938570
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Entity Type | Organization
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Legal Business Name | LASER SURGERY CENTER OF NORTHERN CALIFORNIA LTD
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 2021 YGNACIO VALLEY RD BLDG H STE 102
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City | WALNUT CREEK
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State | CA
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Zip | 94598
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Country | US
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Telephone | 925-944-9400
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Fax | 925-947-2160
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Provider Business Mailing Address
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Address Line | 2021 YGNACIO VALLEY RD BLDG H STE 102
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City | WALNUT CREEK
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State | CA
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Zip | 94598
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Country | US
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Telephone | 925-944-9400
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Fax | 925-947-2160
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MICHELE E MCKINLEY
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Credential |
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Telephone | 925-944-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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