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General NPI Number Information
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NPI Number | 1639691397
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Entity Type | Organization
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Legal Business Name | SARAH APOLLO DT PC
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 07/28/2017
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Provider Practice Location Address
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Address Line | 22 ODYSSEY STE 155
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City | IRVINE
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State | CA
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Zip | 92618-3194
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Country | US
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Telephone | 714-202-7909
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Fax | 866-242-5109
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Provider Business Mailing Address
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Address Line | PO BOX 36
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City | DANA POINT
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State | CA
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Zip | 92629-0036
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Country | US
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Telephone | 714-202-7909
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Fax | 866-242-5109
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Authorized Official
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Title or Position | CLINIC MANGER
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Name | DEBRA L SANDERSON
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Credential |
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Telephone | 661-993-8941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 20A6613
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 20A6613
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License Number State | CA
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