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General NPI Number Information
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NPI Number | 1982137212
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Entity Type | Individual
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Provider Name | AMANDA L JAMAL
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Gender | Female
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 401 PARADISE RD
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City | MODESTO
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State | CA
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Zip | 95351-3163
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Country | US
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Telephone | 209-558-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 260 W COURT ST APT 26
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City | WOODLAND
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State | CA
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Zip | 95695-2562
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Country | US
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Telephone | 916-209-0401
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A159540
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License Number State | CA
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