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General NPI Number Information
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NPI Number | 1861576480
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Entity Type | Individual
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Provider Name | MARY SHIRLEY ROMO M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 5101 FLORENCE AVE SUITE 5
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City | BELL
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State | CA
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Zip | 90201-3801
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Country | US
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Telephone | 323-562-6930
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Fax | 323-562-6798
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Provider Business Mailing Address
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Address Line | PO BOX 2279
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-1579
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Country | US
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Telephone | 323-562-6930
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Fax | 323-562-6798
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | G64064
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License Number State | CA
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