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General NPI Number Information
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NPI Number | 1871794883
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Entity Type | Organization
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Legal Business Name | SANDS-SMITH
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 995 GATEWAY CENTER WAY STE 108
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City | SAN DIEGO
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State | CA
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Zip | 92102-4544
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Country | US
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Telephone | 858-551-0276
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Fax | 848-454-9796
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Provider Business Mailing Address
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Address Line | PO BOX 9032
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City | LA JOLLA
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State | CA
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Zip | 92038-9032
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Country | US
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Telephone | 858-551-0276
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | DR. MARIACECILIA SMITHLANATTA
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Credential | DDS
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Telephone | 858-551-0276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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