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General NPI Number Information
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NPI Number | 1720135726
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Entity Type | Individual
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Provider Name | MIKE MANSOUR ROSTAMI M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 1119 N WESTERN AVE STE G
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City | LOS ANGELES
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State | CA
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Zip | 90029-1070
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Country | US
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Telephone | 323-957-9300
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Fax | 323-957-9315
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Provider Business Mailing Address
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Address Line | 703 N RODEO DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-3209
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Country | US
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Telephone | 323-957-9300
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Fax | 323-957-9315
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A50108
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License Number State | CA
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