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General NPI Number Information
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NPI Number | 1912566209
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Entity Type | Individual
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Provider Name | RYAN MATTHEW HOM PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 814 FRANCISCO ST
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City | LOS ANGELES
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State | CA
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Zip | 90017-2530
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Country | US
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Telephone | 310-491-7070
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11013
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City | BURBANK
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State | CA
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Zip | 91510-1013
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Country | US
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Telephone | 818-669-1131
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA56865
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License Number State | CA
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