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General NPI Number Information
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NPI Number | 1306121553
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Entity Type | Organization
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Legal Business Name | MEDHEALTH
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | EL AMAL PLAZA 282 AVE JESUS T PINERO
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City | HATO REY
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-957-6225
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Fax |
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Provider Business Mailing Address
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Address Line | METRO PLZ # 1801 C/303 VILLAMIL
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City | SAN JUAN
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State | PR
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Zip | 00907-2829
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Country | US
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Telephone | 787-529-3102
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMAH ALI-SHEHADEH
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Credential | MD
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Telephone | 787-529-3102
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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 | 15488
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License Number State | PR
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