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General NPI Number Information
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NPI Number | 1801160460
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Entity Type | Organization
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Legal Business Name | CYNTHIA MATHIS MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8930 S SEPULVEDA BLVD STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90045-3624
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Country | US
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Telephone | 310-641-8111
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Fax | 310-337-7274
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Provider Business Mailing Address
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Address Line | PO BOX 9789
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City | MARINA DEL REY
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State | CA
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Zip | 90295-2189
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Country | US
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Telephone | 310-577-8500
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Fax | 310-305-7119
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Authorized Official
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Title or Position | OWNER
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Name | DR. CYNTHIA M MATHIS
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Credential | M.D.
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Telephone | 310-641-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | G79441
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License Number State | CA
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