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General NPI Number Information
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NPI Number | 1154032746
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Entity Type | Individual
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Provider Name | GABRIELA BASTIDAS MORA MD
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Gender | Female
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 655 W 8TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 904-244-1680
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Fax |
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Provider Business Mailing Address
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Address Line | 7800 POINT MEADOWS DR APT 422
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4613
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Country | US
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Telephone | 904-684-0117
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MCF1872
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License Number State | FL
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