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General NPI Number Information
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NPI Number | 1801184841
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Entity Type | Organization
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Legal Business Name | MAYWOOD FAMILY MEDICAL CENTER
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 07/12/2011
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Provider Practice Location Address
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Address Line | 5920 ATLANTIC BLVD
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City | MAYWOOD
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State | CA
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Zip | 90270-3101
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Country | US
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Telephone | 323-562-2535
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Fax | 323-562-2558
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Provider Business Mailing Address
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Address Line | 5920 ATLANTIC BLVD
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City | MAYWOOD
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State | CA
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Zip | 90270-3101
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Country | US
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Telephone | 323-562-2535
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Fax | 323-562-2558
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. RAGAA Z. ISKAROUS
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Credential | M.D.
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Telephone | 562-522-7413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A45155
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License Number State | CA
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