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General NPI Number Information
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NPI Number | 1407426380
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Entity Type | Organization
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Legal Business Name | DESERT PARADISE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 5690 W CHANDLER BLVD STE 2
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City | CHANDLER
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State | AZ
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Zip | 85226-3356
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Country | US
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Telephone | 480-878-7425
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 36
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City | TEMPE
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State | AZ
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Zip | 85280-0036
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | MOHAMMAD IQBAL UDDIN
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Credential | MD
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Telephone | 480-755-2366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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