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General NPI Number Information
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NPI Number | 1932425899
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Entity Type | Organization
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Legal Business Name | SANTA TERESITA MEDICAL CLINIC GROUP INC
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 2929 N BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90031-2602
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Country | US
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Telephone | 323-222-5550
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Fax | 323-222-5552
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Provider Business Mailing Address
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Address Line | 2929 N BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90031-2602
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Country | US
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Telephone | 323-222-5550
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Fax | 323-222-5552
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Authorized Official
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Title or Position | OWNER
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Name | MELVIN LEWIS
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Credential | M. D
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Telephone | 323-222-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A51248
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License Number State | CA
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