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General NPI Number Information
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NPI Number | 1427286772
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Entity Type | Organization
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Legal Business Name | CENTRO MEDICO LATINO AMERICANO DE WEST PALM BEACH CORP
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 1217 S MILITARY TRL SUITE C
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City | WEST PALM BEACH
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State | FL
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Zip | 33415-4600
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Country | US
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Telephone | 561-642-6309
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Fax | 561-642-6586
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Provider Business Mailing Address
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Address Line | 1217 SOUTH MILITARY TRIAL SUITE C
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City | WEST PALM BEACH
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State | FL
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Zip | 33415
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Country | US
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Telephone | 561-642-6309
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Fax | 561-642-6586
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICARDO MARTINEZ
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Credential |
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Telephone | 786-395-6708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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