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General NPI Number Information
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NPI Number | 1720808686
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Entity Type | Organization
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Legal Business Name | RENEWAL BOUTIQUE
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 24401 HEALTH CENTER DR STE 202
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3615
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Country | US
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Telephone | 949-328-9026
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Fax | 949-328-9187
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Provider Business Mailing Address
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Address Line | 24401 HEALTH CENTER DR STE 202
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3615
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Country | US
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Telephone | 949-328-9026
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Fax | 949-328-9187
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Authorized Official
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Title or Position | OWNER
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Name | GARY TOLER
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Credential |
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Telephone | 949-533-3282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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