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General NPI Number Information
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NPI Number | 1770698607
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Entity Type | Organization
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Legal Business Name | ESHAGH EZRA M.D., INC.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15424 NORDHOFF ST SUITE B
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City | NORTH HILLS
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State | CA
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Zip | 91343-6951
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Country | US
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Telephone | 818-891-5500
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Fax | 818-891-5505
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Provider Business Mailing Address
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Address Line | 22716 PAUL REVERE DR
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City | CALABASAS
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State | CA
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Zip | 91302-4812
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Country | US
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Telephone | 818-891-5500
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Fax | 818-891-5505
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Authorized Official
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Title or Position | OWNER
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Name | ESHAGH EZRA
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Credential | M.D.
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Telephone | 818-891-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A56249
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License Number State | CA
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