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General NPI Number Information
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NPI Number | 1992108898
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Entity Type | Organization
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Legal Business Name | BREAST CARE SPECIALISTS MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 24401 HEALTH CENTER DR
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3615
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Country | US
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Telephone | 949-452-7200
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Fax | 775-624-9774
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Provider Business Mailing Address
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Address Line | PO BOX 51787
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City | LOS ANGELES
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State | CA
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Zip | 90051-6087
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Country | US
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Telephone | 949-452-7200
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Fax | 775-624-9774
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Authorized Official
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Title or Position | OWNER/CEO
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Name | GARY M. LEVINE
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Credential | MD
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Telephone | 949-452-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G64219
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License Number State | CA
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