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General NPI Number Information
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NPI Number | 1720356751
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Entity Type | Organization
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Legal Business Name | IVY DELL RANCH
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 25119 N CENTRE CITY PKWY
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City | ESCONDIDO
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State | CA
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Zip | 92026-8902
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Country | US
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Telephone | 760-443-5795
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Fax |
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Provider Business Mailing Address
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Address Line | 1656 ANDORRE GLN
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City | ESCONDIDO
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State | CA
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Zip | 92029-6642
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Country | US
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Telephone | 760-443-5795
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Fax | 760-738-6237
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Authorized Official
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Title or Position | LICENSEE
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Name | JULITA RAMIREZ
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Credential | RN
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Telephone | 760-443-5795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State | CA
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