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General NPI Number Information
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NPI Number | 1114118676
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Entity Type | Individual
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Provider Name | JUAN CARLOS MARTINEZ-MORENO M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 3017 W CHARLESTON BLVD SUITE 90
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City | LAS VEGAS
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State | NV
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Zip | 89102-1941
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Country | US
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Telephone | 702-826-2816
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Fax | 702-826-2813
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Provider Business Mailing Address
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Address Line | 3017 W CHARLESTON BLVD SUITE 90
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City | LAS VEGAS
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State | NV
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Zip | 89102-1941
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Country | US
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Telephone | 702-826-2816
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Fax | 702-826-2813
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 16826
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License Number State | PR
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