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General NPI Number Information
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NPI Number | 1316331259
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Entity Type | Individual
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Provider Name | SUSAN PATRICIA ANDUAGA BOCANEGRA MD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 4200 E CAMELBACK RD STE 202
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City | PHOENIX
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State | AZ
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Zip | 85018-2718
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Country | US
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Telephone | 602-229-2200
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Fax | 602-744-3929
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Provider Business Mailing Address
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Address Line | 4200 E CAMELBACK RD STE 202
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City | PHOENIX
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State | AZ
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Zip | 85018-2718
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Country | US
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Telephone | 602-229-2200
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Fax | 602-744-3929
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 58314
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 58314
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License Number State | AZ
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