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General NPI Number Information
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NPI Number | 1124738133
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Entity Type | Organization
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Legal Business Name | PROMED HEALTHCARE CLINIC LLC
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 9370 SW 72ND ST STE A150
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City | MIAMI
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State | FL
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Zip | 33173-5461
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Country | US
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Telephone | 305-639-8095
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Fax | 305-392-0775
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Provider Business Mailing Address
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Address Line | 9370 SW 72ND ST STE A150
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City | MIAMI
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State | FL
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Zip | 33173-5461
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MAGALY TRAVIESO
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Credential | ARNP
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Telephone | 786-580-1859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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