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General NPI Number Information
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NPI Number | 1356506844
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Entity Type | Organization
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Legal Business Name | GRUPO MEDICO SAN CARLOS
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 1866 AVE PONCE DE LEON
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City | SAN JUAN
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State | PR
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Zip | 00909-2010
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Country | US
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Telephone | 787-268-4433
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Fax | 787-726-1828
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Provider Business Mailing Address
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Address Line | BOX 19209 FDEZ JUNCOS STATION
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City | SAN JUAN
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State | PR
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Zip | 00910-1209
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Country | US
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Telephone | 787-268-4433
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Fax | 787-726-1828
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DAISY VILLA
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Credential |
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Telephone | 787-268-4433
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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 | 09-B-3148
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License Number State | PR
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