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General NPI Number Information
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NPI Number | 1386293199
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Entity Type | Organization
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Legal Business Name | CENTRO DE VACUNACION DEL NORTE LLC
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Dates
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Enumeration Date | 09/05/2019
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | BO SABANA CARR 693 KM 14
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City | VEGA ALTA
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State | PR
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Zip | 00692
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Country | US
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Telephone | 787-461-9275
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Fax |
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Provider Business Mailing Address
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Address Line | R11 CALLE BRISAS
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City | DORADO
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State | PR
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Zip | 00646-2160
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Country | US
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Telephone | 787-461-9275
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | WILLIAM SANTANA OLIVO
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Credential |
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Telephone | 787-461-9275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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