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General NPI Number Information
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NPI Number | 1992717375
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Entity Type | Organization
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Legal Business Name | WESTERN MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1820 41ST AVE STE D
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City | CAPITOLA
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State | CA
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Zip | 95010-2516
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Country | US
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Telephone | 831-476-3000
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Fax | 831-476-9009
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Provider Business Mailing Address
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Address Line | 1595 SOQUEL DR STE 330
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1722
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Country | US
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Telephone | 831-465-7778
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Fax | 831-475-0351
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. ROBERT KEET
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Credential | M.D.
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Telephone | 831-465-7778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | CA
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