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General NPI Number Information
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NPI Number | 1407094212
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Entity Type | Organization
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Legal Business Name | SANTA ROSA CLINIC, PA
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 355 RICHARDSON RD SE STE 6
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City | CALHOUN
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State | GA
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Zip | 30701-3681
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Country | US
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Telephone | 706-625-2237
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Fax | 706-625-2239
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Provider Business Mailing Address
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Address Line | 355 RICHARDSON RD SE STE 6
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City | CALHOUN
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State | GA
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Zip | 30701-3681
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Country | US
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Telephone | 706-625-2237
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Fax | 706-625-2239
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUAN CARLOS MALPARTIDA
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Credential | MD
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Telephone | 706-259-5579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 53528
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 50406
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License Number State | GA
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