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General NPI Number Information
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NPI Number | 1023023421
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Entity Type | Organization
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Legal Business Name | SHARYLAND IMAGING CENTER
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2121 E GRIFFIN PKWY STE 2
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City | MISSION
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State | TX
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Zip | 78572-3072
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Country | US
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Telephone | 956-583-7003
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 E GRIFFIN PKWY STE 2
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City | MISSION
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State | TX
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Zip | 78572-3072
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Country | US
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Telephone | 956-583-7003
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. NORMA CAVAZOS
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Credential | D.O.
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Telephone | 956-583-7007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | R28874
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License Number State | TX
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