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General NPI Number Information
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NPI Number | 1417698176
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Entity Type | Individual
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Provider Name | VANESSA CHIQUINQUIRA ROJAS MADURO
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Gender | Female
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 3201 BUDINGER AVE
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City | SAINT CLOUD
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State | FL
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Zip | 34769-7203
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Country | US
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Telephone | 407-498-4079
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Fax |
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Provider Business Mailing Address
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Address Line | 2649 HARMONIA HAMMOCK RD
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City | HARMONY
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State | FL
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Zip | 34773-6153
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | FL
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