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General NPI Number Information
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NPI Number | 1336378322
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Entity Type | Organization
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Legal Business Name | SAM MEDICAL CENTER CORP.
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 07/10/2009
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Provider Practice Location Address
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Address Line | 330 SW 27TH AVE STE 301
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City | MIAMI
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State | FL
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Zip | 33135-2957
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Country | US
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Telephone | 786-431-5905
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Fax | 786-431-5908
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Provider Business Mailing Address
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Address Line | 330 SW 27TH AVE STE 301
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City | MIAMI
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State | FL
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Zip | 33135-2957
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Country | US
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Telephone | 786-431-5905
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Fax | 786-431-5908
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PABLO SICILIA
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Credential | MR
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Telephone | 786-431-5905
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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 | MA 51624
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License Number State | FL
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