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General NPI Number Information
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NPI Number | 1811920846
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE CARE ID MEDICAL GROUP
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8635 W 3RD ST SUITE 1185-W
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City | LOS ANGELES
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State | CA
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Zip | 90048-6101
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Country | US
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Telephone | 310-855-1960
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Fax | 310-855-0156
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Provider Business Mailing Address
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Address Line | 8635 W 3RD ST SUITE 1185-W
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City | LOS ANGELES
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State | CA
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Zip | 90048-6101
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Country | US
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Telephone | 310-855-1960
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Fax | 310-855-0156
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Authorized Official
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Title or Position | DIRECTOR
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Name | IRVING POSALSKI
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Credential | M.D.
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Telephone | 310-855-1960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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