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General NPI Number Information
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NPI Number | 1699863621
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Entity Type | Individual
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Provider Name | PETER MORRIS ROTHENBERG M.D.,M.A.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 657 CAMINO DE LOS MARES SUITE 137
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2826
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Country | US
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Telephone | 949-489-9039
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Fax | 949-489-8136
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Provider Business Mailing Address
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Address Line | 657 CAMINO DE LOS MARES SUITE 137
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2826
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Country | US
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Telephone | 949-489-9039
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Fax | 949-489-8136
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | G47158
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License Number State | CA
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