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General NPI Number Information
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NPI Number | 1740189448
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Entity Type | Individual
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Provider Name | JACKSON IRVING NOL
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Gender | Male
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 757 WESTWOOD PLZ
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City | LOS ANGELES
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State | CA
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Zip | 90095-8358
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Country | US
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Telephone | 310-849-0955
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Fax |
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Provider Business Mailing Address
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Address Line | 137 1/2 S BEDFORD DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-2215
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Country | US
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Telephone | 310-849-0955
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Fax |
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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 | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | E172312
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License Number State | CA
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