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General NPI Number Information
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NPI Number | 1053573543
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Entity Type | Organization
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Legal Business Name | HOME MEDIC COORDINATION
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | AVE LUIS MUNOZ RIVERA EDIF 91 ALTOS
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City | SANTA ISABEL
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State | PR
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Zip | 00757
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Country | US
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Telephone | 787-845-1188
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Fax | 787-845-2653
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Provider Business Mailing Address
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Address Line | PO BOX 57
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City | SANTA ISABEL
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State | PR
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Zip | 00757-0057
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Country | US
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Telephone | 787-845-1188
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Fax | 787-845-2653
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CARLOS LUIS LEON
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Credential |
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Telephone | 787-845-1188
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | PR
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