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General NPI Number Information
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NPI Number | 1902392095
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Entity Type | Organization
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Legal Business Name | MEDSTAR HOME HEALTH, INC.
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 21221 S WESTERN AVE STE 140 ROOM 1608
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City | TORRANCE
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State | CA
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Zip | 90501-2972
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Country | US
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Telephone | 818-967-5544
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Fax | 818-967-5445
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Provider Business Mailing Address
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Address Line | 21221 S WESTERN AVE STE 140 ROOM 1608
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City | TORRANCE
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State | CA
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Zip | 90501-2972
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Country | US
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Telephone | 818-967-5544
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Fax | 818-967-5445
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. ERICKSON CRUZ BAUTISTA
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Credential | DNP MSN-AGNP
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Telephone | 818-967-5544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | CA
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