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General NPI Number Information
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NPI Number | 1740540285
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Entity Type | Organization
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Legal Business Name | VDAH CORP
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Dates
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Enumeration Date | 05/17/2012
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 2309 ANTONIO AVE
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City | CAMARILLO
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State | CA
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Zip | 93010-1414
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Country | US
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Telephone | 323-447-2259
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Fax |
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Provider Business Mailing Address
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Address Line | 3697 EL ENCANTO DR
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City | CALABASAS
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State | CA
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Zip | 91302-3593
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Country | US
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Telephone | 323-447-2259
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HAIMESH SHAH
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Credential | MD
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Telephone | 323-447-2259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A108019
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | A108019
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License Number State | CA
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