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General NPI Number Information
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NPI Number | 1790323640
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Entity Type | Individual
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Provider Name | MICHELLE BETH IANKOWITZ
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Gender | Female
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 1000 QUAIL ST STE 175
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2766
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Country | US
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Telephone | 310-595-8362
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Fax |
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Provider Business Mailing Address
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Address Line | 17200 NEWHOPE ST APT 32A
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4248
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Country | US
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Telephone | 310-595-8362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 93348
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License Number State | CA
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