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General NPI Number Information
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NPI Number | 1689117137
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Entity Type | Organization
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Legal Business Name | SAN LUIS REY MEDICAL GROUP
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 27710 JEFFERSON AVE STE 207
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City | TEMECULA
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State | CA
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Zip | 92590-4604
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Country | US
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Telephone | 833-668-6676
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Fax | 866-299-8639
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Provider Business Mailing Address
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Address Line | 6400 OAK CYN SUITE 200
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City | IRVINE
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State | CA
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Zip | 92618-5203
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Country | US
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Telephone | 858-229-6156
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Fax |
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Authorized Official
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Title or Position | SR VP OPERATIONS
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Name | ANGELA MOUTON
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Credential |
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Telephone | 949-240-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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