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General NPI Number Information
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NPI Number | 1760005052
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Entity Type | Individual
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Provider Name | ANGELITO ENCABO ORTIZ
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Gender | Male
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 15099 MISSION HILLS RD
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City | MISSION HILLS
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State | CA
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Zip | 91345-1102
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Country | US
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Telephone | 819-837-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 11357 EDENBERG AVE
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City | PORTER RANCH
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State | CA
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Zip | 91326-2107
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Country | US
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Telephone | 818-648-7032
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA6918
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License Number State | CA
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