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General NPI Number Information
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NPI Number | 1255879474
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Entity Type | Organization
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Legal Business Name | CENTRO DE VACUNACION Y SERVIVIOS INTEGRADOS DE SALUD,INC.
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Dates
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Enumeration Date | 02/08/2017
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | CARRETERA 402 4.6KM BOX PINALES
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City | ANASCO
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State | PR
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Zip | 00610
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Country | US
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Telephone | 787-229-1110
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Fax | 787-229-1110
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Provider Business Mailing Address
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Address Line | RR 2 BOX 2725
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City | ANASCO
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State | PR
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Zip | 00610-9602
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Country | US
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Telephone | 787-229-1110
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Fax | 787-229-1110
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ADOLFO MATIAS
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Credential |
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Telephone | 787-229-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 14771
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 029804
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License Number State | PR
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