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General NPI Number Information
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NPI Number | 1811339856
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Entity Type | Organization
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Legal Business Name | LOUIS T BASCOY, M.D., INC.
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Dates
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Enumeration Date | 07/18/2013
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | 4560 E CESAR E CHAVEZ AVE
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City | LOS ANGELES
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State | CA
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Zip | 90022-1117
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Country | US
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Telephone | 323-269-0411
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Fax | 323-269-0418
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Provider Business Mailing Address
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Address Line | 4560 E CESAR E CHAVEZ AVE
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City | LOS ANGELES
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State | CA
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Zip | 90022-1117
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Country | US
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Telephone | 323-269-0411
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Fax | 323-269-0418
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. LOUIS T. BASCOY
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Credential | M.D.
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Telephone | 323-269-0411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A29037
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License Number State | CA
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