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General NPI Number Information
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NPI Number | 1669686663
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Entity Type | Individual
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Provider Name | MS. DENISSE ANABEL CARRILLO
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Gender | Female
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2008 N GAREY AVE
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City | POMONA
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State | CA
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Zip | 91767-2722
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Country | US
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Telephone | 909-623-6131
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Fax | 909-865-9281
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Provider Business Mailing Address
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Address Line | 1441 PASO REAL AVE SPACE 16
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-2149
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Country | US
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Telephone | 626-581-3492
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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