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General NPI Number Information
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NPI Number | 1659350510
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Entity Type | Organization
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Legal Business Name | MOHTASHAM SHALIKAR
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 6570 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2410
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Country | US
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Telephone | 951-343-1082
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Fax | 951-343-1363
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Provider Business Mailing Address
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Address Line | 6570 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2410
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Country | US
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Telephone | 951-343-1082
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Fax | 951-343-1363
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Authorized Official
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Title or Position | OWNER MANAGER
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Name | MR. MOHTASHAM SHALIKAR
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Credential | MASTER OF ART IN POP
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Telephone | 951-343-1082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 100945
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License Number State | CA
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