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General NPI Number Information
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NPI Number | 1396974853
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Entity Type | Organization
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Legal Business Name | CENTRO DE SALUD FAMILIAR II , LLC
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 4921 JONESBORO RD SUITE E
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City | FOREST PARK
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State | GA
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Zip | 30297-4301
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Country | US
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Telephone | 404-361-0303
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Fax | 404-361-0353
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Provider Business Mailing Address
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Address Line | 4921 JONESBORO RD SUITE E
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City | FOREST PARK
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State | GA
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Zip | 30297-4301
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Country | US
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Telephone | 404-361-0303
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Fax | 404-361-0353
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Authorized Official
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Title or Position | MANAGER
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Name | MR. ELISEO VALLEJO
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Credential |
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Telephone | 404-361-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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