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General NPI Number Information
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NPI Number | 1770619843
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Entity Type | Organization
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Legal Business Name | CLINICA DEL ALMA INC.
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Dates
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Enumeration Date | 02/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16402 S VERMONT AVE
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City | GARDENA
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State | CA
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Zip | 90247-4914
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Country | US
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Telephone | 310-756-0198
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Fax | 310-756-0201
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Provider Business Mailing Address
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Address Line | 16402 S VERMONT AVE
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City | GARDENA
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State | CA
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Zip | 90247-4914
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Country | US
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Telephone | 310-756-0198
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Fax | 310-756-0201
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARTHA G. VIDAL
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Credential | M.D.
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Telephone | 310-756-0198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | A78069
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License Number State | CA
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