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General NPI Number Information
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NPI Number | 1861492647
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Entity Type | Individual
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Provider Name | JUAN CARLOS COBO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 24310 MOULTON PKWY STE O #563
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City | LAGUNA HILLS
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State | CA
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Zip | 92637-3306
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Country | US
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Telephone | 949-297-3612
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Fax | 949-495-8258
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Provider Business Mailing Address
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Address Line | 24310 MOULTON PKWY STE O #563
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City | LAGUNA HILLS
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State | CA
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Zip | 92637-3306
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Country | US
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Telephone | 949-297-3612
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Fax | 949-495-8258
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G42070
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License Number State | CA
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