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General NPI Number Information
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NPI Number | 1164317459
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Entity Type | Organization
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Legal Business Name | JU VIDAL MED LLC
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 13301 SW 132ND AVE UNIT 207
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City | MIAMI
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State | FL
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Zip | 33186-6190
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Country | US
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Telephone | 786-701-9081
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Fax |
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Provider Business Mailing Address
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Address Line | 13301 SW 132ND AVE UNIT 207
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City | MIAMI
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State | FL
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Zip | 33186-6190
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Country | US
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Telephone | 786-701-9081
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | JESUS VIDAL GONZALES
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Credential |
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Telephone | 786-701-9081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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