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General NPI Number Information
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NPI Number | 1871773853
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Entity Type | Organization
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Legal Business Name | ELK GROVE PSYCHIATRIC ASSOCIATES, INC.
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 8001 BRUCEVILLE RD
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City | SACRAMENTO
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State | CA
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Zip | 95823-2329
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Country | US
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Telephone | 916-200-0329
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Fax | 916-689-5517
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Provider Business Mailing Address
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Address Line | PO BOX 233977
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City | SACRAMENTO
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State | CA
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Zip | 95823-0449
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Country | US
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Telephone | 916-525-3434
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Fax | 916-525-3433
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANDREA ROSE BATES
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Credential | M.D.
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Telephone | 916-525-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G71770
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License Number State | CA
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