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General NPI Number Information
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NPI Number | 1669933198
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Entity Type | Individual
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Provider Name | KATHERINE NICOLE SAN ROMAN LVN
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Gender | Female
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 03/27/2019
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Provider Practice Location Address
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Address Line | 2220 GIRARD ST
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City | SAN JACINTO
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State | CA
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Zip | 92583-5301
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Country | US
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Telephone | 951-683-6596
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Fax |
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Provider Business Mailing Address
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Address Line | 11483 AARON AVE
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City | BEAUMONT
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State | CA
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Zip | 92223-6263
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Country | US
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Telephone | 909-693-6209
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 283211
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License Number State | CA
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