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General NPI Number Information
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NPI Number | 1720386519
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Entity Type | Organization
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Legal Business Name | SAN DIEGO SURGERY LLC
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 3434 MIDWAY DR 1008
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City | SAN DIEGO
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State | CA
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Zip | 92110-4923
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Country | US
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Telephone | 310-273-8885
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Fax |
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Provider Business Mailing Address
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Address Line | 9903 SANTA MONICA BLVD #811
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-1671
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Country | US
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Telephone | 310-273-8885
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR, B&C
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Name | MS. ARA SALAZAR
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Credential |
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Telephone | 310-273-8885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A84519
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License Number State | CA
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