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General NPI Number Information
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NPI Number | 1417220385
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Entity Type | Organization
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Legal Business Name | ORIENTAL MEDICINE HOLISTIC HEALTH CARE INC.
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 110 N FEDERAL HWY STE 204
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4300
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Country | US
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Telephone | 954-243-9093
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Fax | 954-333-3556
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Provider Business Mailing Address
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Address Line | 3336 OLD OAK LN
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8438
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Country | US
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Telephone | 954-243-9093
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Fax | 954-333-3556
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MRS. CAROLINE GOSSAGE FAXAS
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Credential | A.P.
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Telephone | 954-243-9093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP 3023
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License Number State | FL
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