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General NPI Number Information
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NPI Number | 1396180535
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Entity Type | Organization
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Legal Business Name | MY CLINIC INTEGRAL MEDICAL CENTER INC
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 2711 SW 137TH AVE #93
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City | MIAMI
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State | FL
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Zip | 33175-6359
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Country | US
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Telephone | 305-646-1932
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Fax | 305-967-8106
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Provider Business Mailing Address
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Address Line | 2711 SW 137TH AVE #93
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City | MIAMI
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State | FL
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Zip | 33175-6359
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Country | US
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Telephone | 305-646-1932
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Fax | 305-967-8106
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Authorized Official
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Title or Position | OWNER
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Name | YUSDEIVYS PEREZ
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Credential | MA62083
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Telephone | 786-378-0649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | MA62083
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License Number State | FL
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