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General NPI Number Information
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NPI Number | 1912254681
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Entity Type | Organization
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Legal Business Name | VIRTUAL SOMNOLOGIST, INC
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Dates
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Enumeration Date | 08/12/2012
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 4957 QUINCY ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-2301
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Country | US
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Telephone | 760-607-1722
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Fax |
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Provider Business Mailing Address
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Address Line | 952 SOUTH CLOVERDALE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90036-4817
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Country | US
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Telephone | 760-607-1722
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STERLING L. MALISH
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Credential | M.D.
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Telephone | 626-664-3364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A94784
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License Number State | CA
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