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General NPI Number Information
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NPI Number | 1386650547
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Entity Type | Individual
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Provider Name | JOAQUIN E MOJICA SANTIAGO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 1420 CALLE AMERICO SALAS
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City | SANTURCE
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State | PR
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Zip | 00909-2139
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Country | US
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Telephone | 787-640-3379
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 605
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City | HUMACAO
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State | PR
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Zip | 00792-0605
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Country | US
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Telephone | 787-640-3379
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 5486
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License Number State | PR
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