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General NPI Number Information
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NPI Number | 1912985979
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Entity Type | Individual
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Provider Name | GINA M G DUEL MS PAC
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Gender | Female
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 3900 W COAST HWY STE 330
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4093
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Country | US
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Telephone | 949-764-6090
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Fax | 949-764-6085
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Provider Business Mailing Address
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Address Line | 3900 W COAST HWY STE 330
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4093
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Country | US
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Telephone | 949-764-6090
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Fax | 949-764-6085
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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 |
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License Number State |
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