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General NPI Number Information
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NPI Number | 1922296854
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Entity Type | Organization
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Legal Business Name | SHAHLA P RAHMATULLAH M.D. INC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 4870 BARRANCA PKWY STE 230
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City | IRVINE
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State | CA
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Zip | 92604-4788
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Country | US
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Telephone | 949-653-1300
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Fax | 949-653-1311
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Provider Business Mailing Address
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Address Line | 351 OLD NEWPORT BLVD SUITE 212
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4120
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Country | US
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Telephone | 949-653-1300
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Fax | 949-353-1311
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Authorized Official
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Title or Position | PROVIDER
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Name | MS. SHAHLA P RAHMATULLAH
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Credential | MD
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Telephone | 949-653-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 00C519930
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License Number State | CA
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