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General NPI Number Information
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NPI Number | 1659531994
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Entity Type | Individual
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Provider Name | ARIEL MONSANTO GAVINO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 1673 W BROADWAY STE 6
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City | ANAHEIM
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State | CA
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Zip | 92802-1109
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Country | US
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Telephone | 714-774-5915
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Fax | 714-774-8095
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Provider Business Mailing Address
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Address Line | PO BOX 291307
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City | LOS ANGELES
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State | CA
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Zip | 90029-9307
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Country | US
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Telephone | 480-703-2328
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Fax |
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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 | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number | RCP 18139
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 15737
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | A 118822
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License Number State | CA
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