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General NPI Number Information
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NPI Number | 1275872525
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Entity Type | Organization
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Legal Business Name | CENTRO DE VACUNACION DR. HECTOR SANTIAGO
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Dates
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Enumeration Date | 02/06/2013
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 321 CALLE MENDEZ VIGO
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City | DORADO
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State | PR
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Zip | 00646-4929
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Country | US
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Telephone | 787-796-1719
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | BAYAMON
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State | PR
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Zip | 00960-0068
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Country | US
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Telephone | 787-796-1719
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. VELIA MARTINEZ DE SANTIAGO
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Credential |
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Telephone | 787-796-1719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3155
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License Number State | PR
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