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General NPI Number Information
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NPI Number | 1336593128
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Entity Type | Organization
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Legal Business Name | SOUTH TEXAS WELLNESS CENTER LLC
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 1700 W DOVE AVE UNIT 80
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City | MCALLEN
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State | TX
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Zip | 78504-4462
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Country | US
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Telephone | 956-467-5920
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Fax | 956-928-9464
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Provider Business Mailing Address
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Address Line | 1108 S 1ST 1/2 ST NONE
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City | MCALLEN
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State | TX
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Zip | 78501-1149
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Country | US
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Telephone | 956-381-2747
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Fax | 956-928-9464
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Authorized Official
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Title or Position | MANAGER-OWNER
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Name | MR. JORGE ENRIQUE ROSAS-RAMIREZ
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Credential |
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Telephone | 956-467-5920
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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 |
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License Number State |
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