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General NPI Number Information
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NPI Number | 1144815689
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Entity Type | Individual
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Provider Name | JOHN DELACRUZPORTUGAL
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Gender | Male
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Dates
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Enumeration Date | 03/06/2021
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 9681 BUSINESS CENTER DR STE C
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4579
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Country | US
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Telephone | 909-710-5752
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Fax | 909-363-8773
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Provider Business Mailing Address
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Address Line | 8873 BEACON AVE
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City | HESPERIA
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State | CA
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Zip | 92344-0054
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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 |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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