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General NPI Number Information
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NPI Number | 1972690899
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Entity Type | Organization
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Legal Business Name | MED-PRO FAMILY CLINIC, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 221 E. GLENOAKS BLVD. 130
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City | GLENDALE
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State | CA
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Zip | 91207
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Country | US
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Telephone | 818-549-1713
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Fax | 818-549-1716
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Provider Business Mailing Address
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Address Line | 11017 S. ATLANTIC AVE. 1ST FLOOR
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City | LYNWOOD
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State | CA
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Zip | 90262
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Country | US
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Telephone | 310-635-3800
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Fax | 310-635-5448
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SAYEEDA SULTANA
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Credential | MD
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Telephone | 310-635-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A36908
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License Number State | CA
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