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General NPI Number Information
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NPI Number | 1932256211
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Entity Type | Organization
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Legal Business Name | SOUTH COAST ALLERGY & ASTHMA MEDICAL CORPORATION.
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 12370 HESPERIA RD SUITE 1
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City | VICTORVILLE
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State | CA
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Zip | 92395-7719
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Country | US
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Telephone | 760-245-8645
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Fax | 760-245-6798
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Provider Business Mailing Address
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Address Line | 12370 HESPERIA RD SUITE 1
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City | VICTORVILLE
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State | CA
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Zip | 92395-7719
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Country | US
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Telephone | 760-245-8645
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Fax | 760-245-6798
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CARMELLA M AMAR
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Credential |
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Telephone | 760-245-8645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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