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General NPI Number Information
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NPI Number | 1003774464
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Entity Type | Organization
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Legal Business Name | VEIN CLINIC OF ST CLOUD LLC
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Dates
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Enumeration Date | 01/14/2026
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 720 W OAK ST STE 309
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City | KISSIMMEE
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State | FL
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Zip | 34741-4910
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Country | US
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Telephone | 321-436-1783
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Fax |
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Provider Business Mailing Address
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Address Line | 720 W OAK ST STE 309
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City | KISSIMMEE
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State | FL
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Zip | 34741-4910
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JORGE ANTONIO LARRANAGA
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Credential | MD
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Telephone | 321-436-1783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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