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General NPI Number Information
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NPI Number | 1407043433
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Entity Type | Organization
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Legal Business Name | JOSE LUCIANO FARIAS-JIMENEZ, M.D.,P.A.
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 416 LINDBERG AVE
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City | MCALLEN
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State | TX
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Zip | 78501-2922
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Country | US
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Telephone | 956-630-4161
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Fax | 956-664-1398
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Provider Business Mailing Address
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Address Line | 808 S SHARY RD STE 5NO204
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City | MISSION
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State | TX
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Zip | 78572-8568
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Country | US
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Telephone | 956-630-4161
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Fax | 956-435-0138
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Authorized Official
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Title or Position | OWNER
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Name | JOSE LUCIANO FARIAS-JIMENEZ
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Credential | M.D.
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Telephone | 956-808-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L9192
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License Number State | TX
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