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General NPI Number Information
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NPI Number | 1629039664
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Entity Type | Individual
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Provider Name | RAJIVINDER SINGH BRAR D.O., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 795 E 2ND ST SUITE 5
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City | POMONA
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State | CA
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Zip | 91766-2007
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Country | US
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Telephone | 909-865-2565
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Fax | 909-865-2955
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Provider Business Mailing Address
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Address Line | 1001 RIVERSIDE AVE
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City | ROSEVILLE
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State | CA
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Zip | 95678-5134
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Country | US
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Telephone | 916-784-4050
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Fax | 916-746-4553
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 20A9567
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License Number State | CA
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