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General NPI Number Information
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NPI Number | 1124016308
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Entity Type | Organization
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Legal Business Name | MASTER CARE MEDICAL CENTER INC
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 11865 SW 26TH ST STE J9
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City | MIAMI
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State | FL
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Zip | 33175-2400
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Country | US
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Telephone | 305-223-7913
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Fax | 305-223-7912
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Provider Business Mailing Address
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Address Line | 11865 SW 26TH ST STE J9
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City | MIAMI
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State | FL
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Zip | 33175-2400
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Country | US
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Telephone | 305-223-7913
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Fax | 305-223-7912
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. JUAN DE LA CRUZ GONZALEZ
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Credential |
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Telephone | 305-223-7913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC4904
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License Number State | FL
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