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General NPI Number Information
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NPI Number | 1811267503
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Entity Type | Organization
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Legal Business Name | PROMED PROVIDERS LLC
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 1936 PINEHURST RD
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City | LOS ANGELES
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State | CA
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Zip | 90068-3730
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Country | US
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Telephone | 213-840-0123
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Fax |
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Provider Business Mailing Address
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Address Line | 1936 PINEHURST RD
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City | LOS ANGELES
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State | CA
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Zip | 90068-3730
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD SHINZATO PORTER
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Credential |
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Telephone | 213-840-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SC2300X
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Taxonomy Name | Chronic Care Clinical Nurse Specialist
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License Number |
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License Number State |
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