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General NPI Number Information
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NPI Number | 1689984320
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Entity Type | Individual
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Provider Name | RODOLFO PERNIA CASTRO NP
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Gender | Male
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 10/15/2010
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Provider Practice Location Address
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Address Line | 1523 EAST AMAR ROAD SUITE #2
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City | WEST COVINA
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State | CA
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Zip | 91792-1619
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Country | US
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Telephone | 626-839-9100
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Fax | 626-839-9106
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Provider Business Mailing Address
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Address Line | 618 WEST DRYDEN ST. APT 204
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City | GLENDALE
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State | CA
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Zip | 91202-3303
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Country | US
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Telephone | 626-839-9100
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Fax | 626-839-9106
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 20135
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License Number State | CA
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