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General NPI Number Information
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NPI Number | 1376533034
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Entity Type | Individual
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Provider Name | JOHN JIMENEZ-AGOSTO MD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 59 CALLE SANTA CRUZ FOURTH FLOOR
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City | BAYAMON
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State | PR
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Zip | 00961-6900
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Country | US
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Telephone | 787-717-6240
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Fax |
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Provider Business Mailing Address
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Address Line | C/ LIMONCILLO #73 SANTA MARIA
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City | SAN JUAN
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State | PR
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Zip | 00927-6622
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Country | US
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Telephone | 787-717-6240
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Fax |
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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 | 5724
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License Number State | PR
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