| provider_number | npi_provider_number | owner_number | service_location_number | provider_business_legal_name | enrollment_status_effective_date | provider_type_code | provider_type_code_desc | provider_license_number | provider_specialty_code | provider_specialty_code_desc | out_of_state_ind | out_of_state_ind_desc | provider_address_county_code | provider_address_county_code_description | attention_line | provider_address_line1 | provider_address_line2 | provider_address_city | provider_address_state | provider_address_zip | provider_address_latitude | provider_address_longitude | mssa_id | tract_id |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205381647 | 1205381647 | 1 | 1 | QURESHI, AZMATH S MD INC | 9-Feb-98 | Physicians (026) | PHYSICIANS | A36039 | 6 | Cardiovascular Disease (M.D. only) | 0 | In state provider | 19 | Los Angeles | None | 14350 E WHITTIER BLVD | SUITE 230 | WHITTIER | CA | 90604 | 33.955049 | -118.018524 | 78.2uu | 5017 |