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General NPI Number Information
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NPI Number | 1235970286
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Entity Type | Organization
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Legal Business Name | LS RADIANTLIFE HEALTH SERVICES LLC
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | URB VEVE CALZADA CALLE 3A O28
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City | FAJARDO
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State | PR
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Zip | 00738
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Country | US
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Telephone | 939-216-3292
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1503
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City | FAJARDO
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State | PUERTO RICO
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Zip | 00738
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Country | UM
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LIN MARGARET CHU JOY DAVILA
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Credential | MD
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Telephone | 939-216-3292
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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 |
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License Number State |
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