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General NPI Number Information
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NPI Number | 1811570633
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Entity Type | Organization
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Legal Business Name | NEO MEDICAL CENTRE INC
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 1403 LOMITA BLVD STE 307
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City | HARBOR CITY
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State | CA
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Zip | 90710-2085
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Country | US
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Telephone | 424-352-0326
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Fax |
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Provider Business Mailing Address
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Address Line | 1403 LOMITA BLVD STE 307
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City | HARBOR CITY
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State | CA
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Zip | 90710-2085
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Country | US
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Telephone | 424-352-0326
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | JENNIFER I ESTEY
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Credential | MLP-NURSE PRACTITION
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Telephone | 424-352-0326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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