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General NPI Number Information
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NPI Number | 1124775549
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Entity Type | Organization
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Legal Business Name | BLUE PARADISE MEDICAL CENTER LLC
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Dates
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Enumeration Date | 03/05/2022
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Last Update Date | 03/05/2022
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Provider Practice Location Address
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Address Line | 5941 NW 173RD DR UNIT B6
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City | HIALEAH
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State | FL
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Zip | 33015-5109
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Country | US
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Telephone | 786-360-4328
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Fax | 786-409-3696
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Provider Business Mailing Address
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Address Line | 5941 NW 173RD DR UNIT B6
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City | HIALEAH
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State | FL
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Zip | 33015-5109
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Country | US
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Telephone | 786-360-4328
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Fax | 786-409-3696
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JULIO C BRITO MIRANDA
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Credential |
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Telephone | 786-360-4328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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