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General NPI Number Information
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NPI Number | 1649684010
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Entity Type | Individual
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Provider Name | ADEL MAZANDERANI M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 27309 MADISON AVE
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City | TEMECULA
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State | CA
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Zip | 92590-5685
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Country | US
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Telephone | 833-574-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 2654 PEPPERTREE WAY
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City | CARLSBAD
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State | CA
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Zip | 92009-3073
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Country | US
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Telephone | 206-383-2348
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Fax | 805-243-0375
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60675917
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A170150
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License Number State | CA
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