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General NPI Number Information
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NPI Number | 1649646209
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Entity Type | Organization
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Legal Business Name | PRODE P. PASCUAL, M.D., INC.
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 18331 GRIDLEY RD SUITE C
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City | CERRITOS
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State | CA
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Zip | 90703-5438
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Country | US
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Telephone | 562-865-0213
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Fax | 562-865-1050
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Provider Business Mailing Address
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Address Line | 18331 GRIDLEY RD SUITE C
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City | CERRITOS
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State | CA
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Zip | 90703-5438
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Country | US
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Telephone | 562-865-0213
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Fax | 562-865-1050
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Authorized Official
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Title or Position | CEO
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Name | PRODE PASCUAL
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Credential |
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Telephone | 562-865-0213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A30986
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License Number State | CA
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