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General NPI Number Information
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NPI Number | 1932179330
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Entity Type | Individual
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Provider Name | ALFRED C. MA M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 26520 CACTUS AVE ROOM #F2027
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City | MORENO VALLEY
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State | CA
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Zip | 92555
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Country | US
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Telephone | 951-486-4574
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Fax | 951-486-4560
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Provider Business Mailing Address
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Address Line | 4347 PORTAGE ST NW STE 102
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City | NORTH CANTON
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State | OH
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Zip | 44720-7371
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Country | US
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Telephone | 800-527-0336
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Fax | 330-415-1821
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A40866
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License Number State | CA
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