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General NPI Number Information
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NPI Number | 1700866894
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Entity Type | Individual
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Provider Name | MAX VINCO SOLIGUEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1183 E FOOTHILL BLVD SUITE 230
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City | UPLAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 909-920-9050
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Fax | 909-920-9057
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Provider Business Mailing Address
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Address Line | 6246 INDIGO AVE
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City | ALTA LOMA
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State | CA
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Zip | 91701-2551
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Country | US
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Telephone | 909-466-9160
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Fax | 909-466-9160
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A56150
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License Number State | CA
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