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General NPI Number Information
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NPI Number | 1689925729
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Entity Type | Organization
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Legal Business Name | NORTHEAST VALLEY HEALTH CORPORATION
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 26974 RAINBOW GLEN DR
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City | SANTA CLARITA
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State | CA
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Zip | 91351-4875
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Country | US
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Telephone | 661-673-8888
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Fax | 661-298-8668
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Provider Business Mailing Address
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Address Line | 1172 N MACLAY AVE
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City | SAN FERNANDO
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State | CA
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Zip | 91340-1328
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Country | US
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Telephone | 818-898-1388
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Fax | 818-365-4031
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. KIMBERLY WYARD
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Credential |
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Telephone | 818-898-1388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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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 | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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