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General NPI Number Information
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NPI Number | 1649968462
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Entity Type | Organization
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Legal Business Name | SYNERGY MED
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Dates
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Enumeration Date | 04/28/2023
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 1801 E MARCH LN STE D460
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City | STOCKTON
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State | CA
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Zip | 95210-6680
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Country | US
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Telephone | 209-472-2300
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Fax | 209-472-2446
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Provider Business Mailing Address
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Address Line | 1801 E MARCH LN STE D460
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City | STOCKTON
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State | CA
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Zip | 95210-6680
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Country | US
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Telephone | 209-472-2300
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Fax | 209-472-2446
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SAHITHI MUPPAVARAPU
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Credential | MBBS
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Telephone | 209-472-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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