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General NPI Number Information
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NPI Number | 1801088117
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Entity Type | Organization
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Legal Business Name | SUSAN E SPRAU MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 200 UCLA MEDICAL PLZ SUITE B265-29
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City | LOS ANGELES
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State | CA
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Zip | 90095-8344
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Country | US
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Telephone | 310-453-3989
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Fax | 310-453-2154
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Provider Business Mailing Address
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Address Line | PO BOX 280655
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City | NORTHRIDGE
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State | CA
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Zip | 91328-0655
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Country | US
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Telephone | 310-453-3989
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Fax | 310-453-2154
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN SPRAU
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Credential | M.D.
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Telephone | 310-453-3989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | G44652
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License Number State | CA
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