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General NPI Number Information
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NPI Number | 1871769000
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Entity Type | Organization
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Legal Business Name | MED CENTER MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 7988 CALIFORNIA AVE
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City | FAIR OAKS
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State | CA
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Zip | 95628-7140
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Country | US
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Telephone | 916-961-7031
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Fax | 916-961-5218
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Provider Business Mailing Address
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Address Line | 6060 SUNRISE VISTA DR STE 3050
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-7053
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Country | US
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Telephone | 916-676-1450
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Fax | 916-676-1447
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CINDY ADGE
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Credential |
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Telephone | 916-676-1450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10071
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License Number State | CA
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