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General NPI Number Information
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NPI Number | 1699711556
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Entity Type | Organization
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Legal Business Name | ESCNC LLC
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 1386 LEAD HILL BLVD STE 130
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City | ROSEVILLE
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State | CA
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Zip | 95661-2936
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Country | US
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Telephone | 916-723-7400
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Fax | 916-723-4449
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Provider Business Mailing Address
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Address Line | 75 ENTERPRISE STE 200
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City | ALISO VIEJO
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State | CA
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Zip | 92656-2626
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Country | US
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Telephone | 949-688-6205
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Fax | 949-688-6205
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Authorized Official
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Title or Position | OWNER
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Name | DR. MUJAHID HINES
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Credential | MD
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Telephone | 916-723-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 030000363
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 030000363
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License Number State | CA
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