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General NPI Number Information
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NPI Number | 1801100839
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Entity Type | Organization
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Legal Business Name | MAXIMA THERAPY AND SPEECH CLINIC, INC.
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 5217 ETIWANDA AVE
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City | TARZANA
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State | CA
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Zip | 91356-4335
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Country | US
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Telephone | 509-430-1111
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Fax | 818-704-7898
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Provider Business Mailing Address
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Address Line | 3940 LAUREL CANYON BLVD SUITE 456
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City | STUDIO CITY
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State | CA
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Zip | 91604-3709
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Country | US
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Telephone | 818-287-8875
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Fax | 818-704-7898
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Authorized Official
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Title or Position | CEO
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Name | MR. ANTON ZUBATOV
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Credential | B.S.
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Telephone | 509-430-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | SP 13829
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License Number State | CA
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