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General NPI Number Information
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NPI Number | 1164745154
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Entity Type | Organization
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Legal Business Name | RAUL ALONSO MDPA
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Dates
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Enumeration Date | 03/05/2010
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Last Update Date | 01/07/2024
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Provider Practice Location Address
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Address Line | 290 W 49TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-3763
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Country | US
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Telephone | 305-824-5517
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Fax | 305-556-6005
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Provider Business Mailing Address
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Address Line | 15476 NW 77TH CT # 708
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City | MIAMI LAKES
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State | FL
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Zip | 33016-5823
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Country | US
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Telephone | 305-824-5517
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Fax | 305-556-6005
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAUL ALONSO
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Credential |
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Telephone | 954-980-3979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME 0072859
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License Number State | FL
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