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General NPI Number Information
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NPI Number | 1649228982
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Entity Type | Organization
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Legal Business Name | ULTIMED MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5300 SANTA MONICA BLVD SUITE 304
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City | LOS ANGELES
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State | CA
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Zip | 90029-1131
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Country | US
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Telephone | 323-993-0700
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Fax | 323-993-0734
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Provider Business Mailing Address
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Address Line | 5300 SANTA MONICA BLVD SUITE 304
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City | LOS ANGELES
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State | CA
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Zip | 90029-1131
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Country | US
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Telephone | 323-993-0700
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Fax | 323-993-0734
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANOLITO SOSA BUENDIA
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Credential | M.D.
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Telephone | 661-799-9585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A53451
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License Number State | CA
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