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General NPI Number Information
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NPI Number | 1336384551
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Entity Type | Organization
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Legal Business Name | REYNOSO MD MEDICAL CENTER LLC
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | 8595 E BELL RD SUITE 103
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-1306
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Country | US
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Telephone | 480-659-1509
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Fax | 480-659-0275
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Provider Business Mailing Address
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Address Line | 8595 E BELL RD SUITE 103
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-1306
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Country | US
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Telephone | 480-659-1509
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Fax | 480-659-0275
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | JENNIFER G REYNOSO
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Credential |
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Telephone | 480-659-1509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12818
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License Number State | AZ
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