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General NPI Number Information
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NPI Number | 1407640477
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Entity Type | Organization
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Legal Business Name | ADVANCED GLAUCOMA CARE
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 611 CALLE PAVIA STE 210
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City | SAN JUAN
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State | PR
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Zip | 00909-2244
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Country | US
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Telephone | 787-728-2318
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Fax |
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Provider Business Mailing Address
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Address Line | 611 CALLE PAVIA STE 210
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City | SAN JUAN
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State | PR
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Zip | 00909-2244
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Country | US
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Telephone | 787-728-2318
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALEJANDRA M SANTIAGO DIAZ
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Credential | MEDICAL DOCTOR
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Telephone | 787-728-2318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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