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General NPI Number Information
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NPI Number | 1649654062
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Entity Type | Organization
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Legal Business Name | FONTANA CARDIOVASCULAR GROUP INC
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 8635 WEST THRID STREET SUITE 750W
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City | LOS ANGELES
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State | CA
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Zip | 90048
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Country | US
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Telephone | 310-659-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 9663 SANTA MONICA BLVD NO 756
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4303
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Country | US
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Telephone | 310-721-2285
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREG P FONTANA
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Credential | MD
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Telephone | 310-721-2285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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