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General NPI Number Information
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NPI Number | 1669651618
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Entity Type | Organization
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Legal Business Name | ALBERT C MAK MD INC
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 707 S GARFIELD AVE BSMT
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City | ALHAMBRA
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State | CA
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Zip | 91801-5859
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Country | US
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Telephone | 805-577-8730
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Fax | 805-991-4065
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Provider Business Mailing Address
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Address Line | PO BOX 80520
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City | SAN MARINO
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State | CA
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Zip | 91118-8520
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Country | US
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Telephone | 805-577-8730
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Fax | 805-991-4065
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. ROSE MARIE RIVERA
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Credential |
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Telephone | 805-577-8730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | G79330
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License Number State | CA
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