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General NPI Number Information
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NPI Number | 1427008929
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Entity Type | Organization
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Legal Business Name | NIDI MEDICAL GROUP CORP
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6031 SW 8TH ST
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City | WEST MIAMI
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State | FL
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Zip | 33144-5039
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Country | US
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Telephone | 305-262-5552
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Fax | 305-262-5575
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Provider Business Mailing Address
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Address Line | 6838 W 25TH AVE
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City | HIALEAH
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State | FL
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Zip | 33016-5467
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Country | US
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Telephone | 305-817-3735
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATION / MANAGER
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Name | MS. NIDIALYS VAZQUEZ
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Credential |
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Telephone | 305-817-3735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC7030
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License Number State | FL
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