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General NPI Number Information
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NPI Number | 1861699621
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Entity Type | Individual
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Provider Name | CRAIG CHASE PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 18710 AMAR RD STE A
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City | WALNUT
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State | CA
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Zip | 91789-4571
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Country | US
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Telephone | 626-522-6553
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Fax | 844-400-1763
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Provider Business Mailing Address
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Address Line | 2028 E EDGECOMB ST
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City | COVINA
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State | CA
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Zip | 91724-2203
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Country | US
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Telephone | 626-965-2334
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Fax | 626-964-6504
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA13105
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License Number State | CA
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