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General NPI Number Information
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NPI Number | 1790414498
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Entity Type | Individual
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Provider Name | JUDITH BOSTON MD
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Gender | Female
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 16755 VON KARMAN AVE STE 200
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City | IRVINE
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State | CA
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Zip | 92606-4963
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Country | US
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Telephone | 949-245-7435
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 N SEPULVEDA BLVD # 387
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5111
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Country | US
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Telephone | 949-245-7435
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A62969
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License Number State | CA
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