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General NPI Number Information
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NPI Number | 1780957860
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Entity Type | Organization
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Legal Business Name | MED IMAGING CARE, INC
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Dates
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Enumeration Date | 02/20/2012
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 3392 MOTOR AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-3712
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Country | US
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Telephone | 734-788-9646
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Fax | 310-424-3404
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Provider Business Mailing Address
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Address Line | 11693 SAN VICENTE BLVD STE 389
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City | LOS ANGELES
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State | CA
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Zip | 90049-5105
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Country | US
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Telephone | 734-788-9646
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Fax | 310-424-3404
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Authorized Official
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Title or Position | CEO
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Name | DR. MOHAMMAD REZVANI
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Credential | MD
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Telephone | 734-788-9646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | A113116
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A113116
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License Number State | CA
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