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General NPI Number Information
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NPI Number | 1225384647
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Entity Type | Organization
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Legal Business Name | MYRNA DIAZ
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 272 CALLE MARINA
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City | AGUADA
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State | PR
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Zip | 00602-2956
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Country | US
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Telephone | 787-868-4593
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 579
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City | MAYAGUEZ
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State | PR
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Zip | 00681-0579
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MYRNA DIAZ
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Credential | 7878684593
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Telephone | 787-868-4593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State | PR
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