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General NPI Number Information
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NPI Number | 1144759515
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Entity Type | Individual
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Provider Name | MONIQUE LA FUENTE OCULARIST
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Gender | Female
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 229 NW 9TH ST # 102
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City | OKLAHOMA CITY
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State | OK
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Zip | 73102-2619
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Country | US
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Telephone | 405-774-0118
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Fax |
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Provider Business Mailing Address
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Address Line | 3215 SE PINTO ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-6506
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Country | US
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Telephone | 405-774-0118
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Fax |
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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 | 156FX1700X
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Taxonomy Name | Ocularist
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License Number |
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License Number State |
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