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General NPI Number Information
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NPI Number | 1740942481
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Entity Type | Individual
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Provider Name | ROSAN MENDOZA DERAYUNAN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 03/04/2023
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Provider Practice Location Address
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Address Line | 1720 E LOS ANGELES AVE STE 231
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City | SIMI VALLEY
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State | CA
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Zip | 93065-5813
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Country | US
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Telephone | 805-980-7574
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Fax | 805-426-8781
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Provider Business Mailing Address
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Address Line | 2788 FYLER PL
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City | LOS ANGELES
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State | CA
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Zip | 90065-5106
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Country | US
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Telephone | 323-317-1769
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95018575
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95018575
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License Number State | CA
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