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General NPI Number Information
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NPI Number | 1154391472
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Entity Type | Individual
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Provider Name | LIBRADA TERESA VAZQUEZ MD
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Gender | Female
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 600 GRANT ST
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City | GARY
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State | IN
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Zip | 46402-6001
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Country | US
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Telephone | 219-886-4573
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 660267
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City | INDIANAPOLIS
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State | IN
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Zip | 46266-0001
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 01037861A
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License Number State | IN
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