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General NPI Number Information
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NPI Number | 1902760333
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Entity Type | Organization
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Legal Business Name | MIRA MACE MEDICAL SERVICES WEST PC
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 2445 AUGUSTINE DR
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City | SANTA CLARA
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State | CA
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Zip | 95054-3032
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Country | US
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Telephone | 332-296-0021
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Fax |
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Provider Business Mailing Address
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Address Line | 1111B S GOVERNORS AVE STE 39475
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City | DOVER
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State | DE
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Zip | 19904-6903
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Country | US
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Telephone | 332-296-0021
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JAGADEESH JAGARLAMUDI
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Credential |
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Telephone | 332-296-0021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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