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General NPI Number Information
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NPI Number | 1083094262
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Entity Type | Organization
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Legal Business Name | CELESTINO LOPEZ OMD LLC
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 900 W 49TH ST SUITE 319
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City | HIALEAH
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State | FL
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Zip | 33012-3402
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Country | US
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Telephone | 786-284-0117
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Fax | 786-558-9320
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Provider Business Mailing Address
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Address Line | 900 W 49TH ST SUITE 319
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City | HIALEAH
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State | FL
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Zip | 33012-3402
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Country | US
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Telephone | 786-284-0117
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Fax | 786-558-9320
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CELESTINO LOPEZ
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Credential | OMD
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Telephone | 786-284-0117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | AP355
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License Number State | FL
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