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General NPI Number Information
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NPI Number | 1396373569
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Entity Type | Individual
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Provider Name | JESUS ERNESTO DIAZ REGALADO
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Gender | Male
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 507 CAPE CORAL PKWY E
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City | CAPE CORAL
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State | FL
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Zip | 33904-8545
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Country | US
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Telephone | 239-541-4420
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Fax | 239-468-7908
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 395-414-4202
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Fax | 239-468-7908
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME163782
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License Number State | FL
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