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General NPI Number Information
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NPI Number | 1003985565
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Entity Type | Individual
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Provider Name | JOAQUIN F SANTILLAN MPT
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 103 LIVINGSTON LOOP SUITE B1
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City | SANTA TERESA
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State | NM
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Zip | 88008-9747
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Country | US
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Telephone | 575-587-7061
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Fax | 915-493-8264
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Provider Business Mailing Address
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Address Line | 4849 N MESA ST STE 201
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City | EL PASO
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State | TX
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Zip | 79912-5919
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Country | US
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Telephone | 915-351-6600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1104438
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4955
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License Number State | NM
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