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General NPI Number Information
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NPI Number | 1023442985
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Entity Type | Individual
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Provider Name | MAIKEL HERNANDEZ DIAZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 3435 KAREN AVE
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City | KINGMAN
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State | AZ
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Zip | 86401-6485
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Country | US
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Telephone | 305-962-2690
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Fax |
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Provider Business Mailing Address
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Address Line | 30295 N 117TH DR
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City | PEORIA
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State | AZ
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Zip | 85383-8255
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Country | US
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Telephone | 305-962-2690
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9107389
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License Number State | FL
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