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General NPI Number Information
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NPI Number | 1316163843
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Entity Type | Organization
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Legal Business Name | CENTRO DE VACUNACION DEL NOROESTE, INC.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | LIRIO F-3 BZN.27 URB. VISTAS DE SAN LOENZO
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City | SAN LORENZO
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State | PR
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Zip | 00754
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Country | US
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Telephone | 787-736-7539
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Fax | 787-736-7539
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Provider Business Mailing Address
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Address Line | PO BOX 7003 CAGUAS
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City | CAGUAS
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State | PR
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Zip | 00726-7003
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Country | US
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Telephone | 787-736-7539
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Fax | 787-736-7539
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Authorized Official
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Title or Position | PRESIDENTE
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Name | MR. FUAD S. ALBA
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Credential |
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Telephone | 787-736-7539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | 1134
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License Number State | PR
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