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General NPI Number Information
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NPI Number | 1396908638
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Entity Type | Organization
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Legal Business Name | PRIMO ABEL MAYHUA
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 900 S BRYAN RD
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City | MISSION
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State | TX
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Zip | 78572-6613
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Country | US
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Telephone | 956-383-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 3807 PLANTATION GROVE BLVD APT G 201
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City | MISSION
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State | TX
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Zip | 78572-7246
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Country | US
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Telephone | 956-369-1787
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Fax | 956-581-9927
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Authorized Official
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Title or Position | CEO
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Name | DR. PRIMO ABEL MAYHUA
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Credential | M.D
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Telephone | 956-369-1787
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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 | M1914
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License Number State | TX
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