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General NPI Number Information
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NPI Number | 1780483719
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Entity Type | Organization
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Legal Business Name | VENICE FAMILY CLINIC
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 23456 HAWTHORNE BLVD STE 260
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City | TORRANCE
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State | CA
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Zip | 90505-4716
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Country | US
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Telephone | 310-593-9594
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Fax |
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Provider Business Mailing Address
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Address Line | 604 ROSE AVE
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City | VENICE
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State | CA
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Zip | 90291-2767
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | ANDREA B BLACKBIRD
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Credential |
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Telephone | 310-664-7941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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