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General NPI Number Information
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NPI Number | 1861304271
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Entity Type | Organization
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Legal Business Name | MAURICE MAYNARD FOUNDATION INC WEST
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Dates
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Enumeration Date | 09/21/2026
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | 4619 AVENUE H
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City | BROOKLYN
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State | NY
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Zip | 11234-1441
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Country | US
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Telephone | 424-508-3827
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Fax |
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Provider Business Mailing Address
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Address Line | 3680 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90010-2707
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Country | US
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Telephone | 424-508-3827
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. NEVON MAURICE WATSON
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Credential |
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Telephone | 424-508-3827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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