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General NPI Number Information
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NPI Number | 1174325559
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Entity Type | Individual
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Provider Name | GUSTAVO VALLEJO MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 1344 S APOLLO BLVD STE 2A
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City | MELBOURNE
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State | FL
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Zip | 32901-3183
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Country | US
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Telephone | 321-722-9731
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Fax | 321-308-0496
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Provider Business Mailing Address
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Address Line | 1344 S APOLLO BLVD STE 406
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City | MELBOURNE
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State | FL
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Zip | 32901-3185
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Country | US
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Telephone | 321-727-2990
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Fax | 321-724-0455
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME172712
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME172712
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME172712
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License Number State |
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