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General NPI Number Information
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NPI Number | 1194251512
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Entity Type | Organization
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Legal Business Name | ENDOHEALTH LLC
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 4 BS AVE LAS AMERICAS URB BAIROA
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-974-7868
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Fax |
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Provider Business Mailing Address
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Address Line | 1575 AVE MUNOZ RIVERA PMB 121
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City | PONCE
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State | PR
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Zip | 00717-0211
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Country | US
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Telephone | 787-974-7868
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | VIVIANA M ORTIZ-SANTIAGO
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Credential |
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Telephone | 787-974-7868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 18803
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License Number State | PR
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