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General NPI Number Information
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NPI Number | 1194367896
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Entity Type | Organization
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Legal Business Name | FORWARD THINKING DELRAY LLC
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 15084 LYONS RD STE 550
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City | DELRAY BEACH
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State | FL
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Zip | 33446-9789
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Country | US
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Telephone | 561-285-4794
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Fax |
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Provider Business Mailing Address
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Address Line | 15084 LYONS RD STE 550
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City | DELRAY BEACH
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State | FL
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Zip | 33446-9789
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Country | US
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Telephone | 561-285-4794
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICARDO MEJIA
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Credential |
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Telephone | 954-770-3681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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