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General NPI Number Information
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NPI Number | 1205020450
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Entity Type | Individual
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Provider Name | LOUISE A DEPODESTA M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 5200 NE 2ND AVE SEASONS HOSPICE & PALLIATIVE CARE
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City | MIAMI
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State | FL
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Zip | 33137-2706
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Country | US
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Telephone | 305-762-0637
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 NE 2ND AVE SEASONS HOSPICE & PALLIATIVE CARE
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City | MIAMI
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State | FL
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Zip | 33137-2706
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Country | US
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Telephone | 305-762-0637
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Fax |
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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 | 2085H0002X
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Taxonomy Name | Hospice and Palliative Medicine (Radiology) Physician
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License Number | 233623
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207VH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
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License Number | ME 129681
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License Number State | FL
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