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General NPI Number Information
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NPI Number | 1104576164
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Entity Type | Individual
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Provider Name | OTONIEL MENDEZ
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Gender | Male
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | CENTRO MEDICO DE PUERTO RICO BARRIO MONACILLOS
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City | SAN JUAN
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State | PR
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Zip | 00935-0001
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Country | US
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Telephone | 787-777-3535
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CARR 2 UNIT 1761
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City | VEGA ALTA
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State | PR
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Zip | 00692-4081
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Country | US
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Telephone | 787-205-3838
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 17091
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License Number State | PR
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