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General NPI Number Information
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NPI Number | 1629321229
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Entity Type | Individual
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Provider Name | MARY APIAFI MOORE M.D
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Gender | Female
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 3910 VISTA WAY STE 106
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City | OCEANSIDE
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State | CA
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Zip | 92056-4513
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Country | US
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Telephone | 760-941-2000
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Fax | 760-941-4900
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Provider Business Mailing Address
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Address Line | 350 N WALL ST
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City | KANKAKEE
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State | IL
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Zip | 60901-2901
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Country | US
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Telephone |
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Fax |
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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 | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 01078699A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | A146394
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License Number State | CA
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