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General NPI Number Information
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NPI Number | 1750301271
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Entity Type | Organization
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Legal Business Name | JAAGMD
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1309 S MARY AVE SUITE NUMBER 135
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City | SUNNYVALE
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State | CA
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Zip | 94087-3050
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Country | US
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Telephone | 408-245-1300
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Fax | 408-245-1305
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Provider Business Mailing Address
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Address Line | 94 AMATO AVE
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City | CAMPBELL
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State | CA
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Zip | 95008-1805
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Country | US
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Telephone | 408-378-4434
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Fax | 408-245-1305
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANGELA ANAGNOS
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Credential | M.D.
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Telephone | 408-378-4434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | G830270
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License Number State | CA
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