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General NPI Number Information
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NPI Number | 1285009613
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Entity Type | Organization
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Legal Business Name | ANGELORUM, INC.
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | CARR 693 KM 13.8 SUITE 171 BO BRENAS
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City | VEGA ALTA
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State | PR
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Zip | 00692
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Country | US
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Telephone | 787-270-3330
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Fax | 787-915-7594
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Provider Business Mailing Address
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Address Line | PO BOX 419
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City | VEGA ALTA
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State | PR
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Zip | 00692-0419
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Country | US
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Telephone | 787-270-3330
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Fax | 787-915-7594
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Authorized Official
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Title or Position | CEO /DIRECTOR MEDIC
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Name | DR. LUIS M GONZALEZ SR.
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Credential | M.D
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Telephone | 787-316-1212
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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 | 9663
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License Number State | PR
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