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General NPI Number Information
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NPI Number | 1407107303
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Entity Type | Organization
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Legal Business Name | WELLNESS CLINICAL SERVICES, LLC
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 31 CALLE SAN BENITO
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City | LAS MARIAS
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State | PR
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Zip | 00670-2103
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Country | US
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Telephone | 787-827-0285
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Fax | 787-827-0285
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Provider Business Mailing Address
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Address Line | PO BOX 3123
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City | MAYAGUEZ
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State | PR
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Zip | 00681-3123
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Country | US
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Telephone | 787-827-0285
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Fax | 787-827-0285
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL LOPEZ
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Credential | M.D.
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Telephone | 787-827-0285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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