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General NPI Number Information
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NPI Number | 1720359953
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Entity Type | Organization
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Legal Business Name | SYDNALEX
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 1048 KOKO HEAD AVE
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City | HONOLULU
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State | HI
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Zip | 96816-3764
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Country | US
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Telephone | 808-734-0255
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Fax | 808-735-1937
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Provider Business Mailing Address
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Address Line | 1048 KOKO HEAD AVE
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City | HONOLULU
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State | HI
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Zip | 96816-3764
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Country | US
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Telephone | 808-734-0255
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Fax | 808-735-1937
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATT J LEARA
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Credential | DVM
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Telephone | 808-734-0255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 609
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License Number State | HI
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