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1154785673
IBARRA GAMBOTA DIANGKINAY
HEMET, CA
NPI
1154785673
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363LA2200X Nurse Practitioner, Adult Health
(Licence: CA 95004040)
Enumeration Date
2016-04-11
Last Update Date
2016-04-11
Business Address
Mr. IBARRA GAMBOTA DIANGKINAY Nurse Practitioner
850 E LATHAM AVE STE 201
HEMET, CA 92543-4391
Phone number: 951-925-6657
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Mailing Address
Mr. IBARRA GAMBOTA DIANGKINAY Nurse Practitioner
850 E LATHAM AVE STE 201
HEMET, CA 92543-4391
Phone number: 951-925-6657
Copy
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