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General NPI Number Information
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NPI Number | 1760684526
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Entity Type | Organization
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Legal Business Name | TEST-MED VACCINATION SERVICES MEDICAL CORP
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 140 E SANTA FE AVE
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City | FULLERTON
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State | CA
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Zip | 92832-1916
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Country | US
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Telephone | 415-595-6734
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Fax | 714-526-3110
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Provider Business Mailing Address
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Address Line | PO BOX 1039
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City | FULLERTON
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State | CA
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Zip | 92836-1039
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Country | US
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Telephone | 415-595-6734
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Fax | 714-526-3110
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Authorized Official
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Title or Position | SECRETARY
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Name | JEFFREY MARCUS WILMOTH
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Credential |
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Telephone | 415-595-6734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | G86894
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License Number State | CA
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