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General NPI Number Information
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NPI Number | 1851604771
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Entity Type | Individual
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Provider Name | CAROLYN LEE TAYLOR PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 321 N LARCHMONT BLVD SUITE 505
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City | LOS ANGELES
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State | CA
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Zip | 90004-3025
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Country | US
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Telephone | 310-975-9546
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Fax | 310-807-8345
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Provider Business Mailing Address
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Address Line | 5371 SANTA CATALINA AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92845-1023
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Country | US
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Telephone | 714-356-8485
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Fax | 310-807-8345
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA19699
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License Number State | CA
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