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General NPI Number Information
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NPI Number | 1043529969
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Entity Type | Organization
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Legal Business Name | JOSE M MATOS
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 116 CALLE CARACOL URB VISTA DEL MAR
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City | RIO GRANDE
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State | PR
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Zip | 00745-4513
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Country | US
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Telephone | 787-206-1797
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 43002 SUITE 431
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City | RIO GRANDE
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State | PR
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Zip | 00745-6601
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Country | US
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Telephone | 787-206-1797
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSE M MATOS
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Credential |
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Telephone | 787-206-1797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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