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General NPI Number Information
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NPI Number | 1821480542
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Entity Type | Organization
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Legal Business Name | LBJ HEALTHCARE PARTNERS, INC
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 13749 CREWE ST
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City | WHITTIER
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State | CA
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Zip | 90605-4008
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Country | US
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Telephone | 562-941-3813
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Fax | 562-941-0589
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Provider Business Mailing Address
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Address Line | 13749 CREWE ST
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City | WHITTIER
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State | CA
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Zip | 90605-4008
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Country | US
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Telephone | 562-941-3813
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Fax | 562-941-0589
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BRIAN BUENVIAJE
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Credential |
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Telephone | 562-941-3813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 306004456
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License Number State | CA
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