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General NPI Number Information
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NPI Number | 1861210767
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Entity Type | Organization
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Legal Business Name | MADI MED LLC
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 2218 SHADYRIDGE AVE
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City | ESCONDIDO
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State | CA
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Zip | 92029-5307
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Country | US
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Telephone | 619-213-7434
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Fax | 619-215-5158
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Provider Business Mailing Address
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Address Line | PO BOX 462122
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City | ESCONDIDO
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State | CA
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Zip | 92046-2122
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Country | US
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Telephone | 619-213-7434
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Fax | 619-215-5158
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMAD AHMADI
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Credential | NP
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Telephone | 619-213-7434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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