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General NPI Number Information
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NPI Number | 1003110107
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Entity Type | Organization
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Legal Business Name | PAMG SELECTO, INC
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 1266 AVE HOSTOS ESQ. POWER
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City | PONCE
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State | PR
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Zip | 00717-0947
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Country | US
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Telephone | 787-813-2325
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Fax | 787-841-3908
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Provider Business Mailing Address
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Address Line | 1266 AVE HOSTOS ESQ. POWER
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City | PONCE
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State | PR
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Zip | 00717-0947
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Country | US
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Telephone | 787-813-2325
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Fax | 787-841-3908
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. LUIS M IRIZARRY
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Credential | M.D.
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Telephone | 787-813-2325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 07-B-2318
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License Number State | PR
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