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General NPI Number Information
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NPI Number | 1679951578
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Entity Type | Organization
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Legal Business Name | NAHEL AL BOUZ MD A PROFESSIONAL MEDICAL CORP
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 811 E 11TH ST STE 203
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City | UPLAND
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State | CA
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Zip | 91786-4872
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Country | US
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Telephone | 909-581-6420
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Fax | 909-982-2322
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Provider Business Mailing Address
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Address Line | 671 REDWOOD LN
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City | SAN DIMAS
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State | CA
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Zip | 91773-3624
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Country | US
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Telephone | 516-241-3595
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. NAHEL AL BOUZ
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Credential | M.D.
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Telephone | 516-241-3595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | CA
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