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General NPI Number Information
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NPI Number | 1114792645
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Entity Type | Individual
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Provider Name | JUAN CADAVID DOM
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Gender | Male
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 553B E 9TH ST
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City | HIALEAH
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State | FL
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Zip | 33010-4549
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Country | US
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Telephone | 786-624-1220
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Fax | 786-206-3071
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Provider Business Mailing Address
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Address Line | 553B E 9TH ST
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City | HIALEAH
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State | FL
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Zip | 33010-4549
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Country | US
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Telephone | 786-624-1220
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Fax | 786-206-3071
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP4523
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License Number State | FL
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