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General NPI Number Information
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NPI Number | 1780713552
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Entity Type | Organization
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Legal Business Name | PODIATRY CARE CENTER OF ONTARIO, LLC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2449 SW 4TH AVE STE 203
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City | ONTARIO
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State | OR
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Zip | 97914-1859
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Country | US
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Telephone | 541-889-8637
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Fax | 541-889-4736
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Provider Business Mailing Address
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Address Line | 1511 W BONNEVILLE CT
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City | NAMPA
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State | ID
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Zip | 83686-9749
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Country | US
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Telephone | 208-463-7732
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Fax | 541-889-4736
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Authorized Official
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Title or Position | CEO
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Name | DR. CAMILLE ELIZABETH HARRIS
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Credential | DPM
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Telephone | 208-463-7732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DP00359
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License Number State | OR
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