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General NPI Number Information
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NPI Number | 1073848958
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Entity Type | Organization
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Legal Business Name | GRUPO RADIOLOGICO DEL CENTRO
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | 3 CALLE HERMANDAD
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City | BARRANQUITAS
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State | PR
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Zip | 00794-1730
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Country | US
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Telephone | 787-857-3900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 429
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City | BARRANQUITAS
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State | PR
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Zip | 00794-0429
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Country | US
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Telephone | 787-857-3900
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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. LUIS RODRIGUEZ LOPEZ
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Credential | M.D.
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Telephone | 787-857-3989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | 1254
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License Number State | PR
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