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General NPI Number Information
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NPI Number | 1396386322
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Entity Type | Organization
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Legal Business Name | NEO MATRIX
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Dates
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Enumeration Date | 10/01/2019
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 290 CLYDE MORRIS BLVD STE D1
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8204
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Country | US
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Telephone | 855-628-7495
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Fax | 407-502-3608
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Provider Business Mailing Address
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Address Line | 290 CLYDE MORRIS BLVD STE D1
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8204
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Country | US
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Telephone | 855-628-7495
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Fax | 407-502-3608
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIA DAILY
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Credential |
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Telephone | 855-628-7495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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