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General NPI Number Information
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NPI Number | 1821377540
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Entity Type | Organization
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Legal Business Name | WEST COAST PHYSIATRY
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 500 S SEPULVEDA BLVD STE 301
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-6976
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Country | US
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Telephone | 424-237-2349
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Fax | 310-388-1358
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Provider Business Mailing Address
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Address Line | 500 S SEPULVEDA BLVD STE 301
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-6976
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Country | US
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Telephone | 424-237-2349
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Fax | 310-388-1358
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. GABRIEL RAYMOND
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Credential | D.O.
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Telephone | 424-237-2349
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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 | 20A9891
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License Number State | CA
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