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General NPI Number Information
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NPI Number | 1629022561
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Entity Type | Organization
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Legal Business Name | MC IBANEZ MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 8100 TIMBERLAKE WAY SUITE C
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City | SACRAMENTO
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State | CA
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Zip | 95823-5409
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Country | US
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Telephone | 916-681-5000
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Fax | 916-681-5887
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Provider Business Mailing Address
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Address Line | 8100 TIMBERLAKE WAY SUITE C
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City | SACRAMENTO
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State | CA
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Zip | 95823-5409
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Country | US
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Telephone | 916-681-5000
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Fax | 916-681-5887
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Authorized Official
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Title or Position | CEO
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Name | MR. CAESAR LOCSIN IBANEZ
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Credential |
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Telephone | 916-681-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A64505
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License Number State | CA
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