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General NPI Number Information
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NPI Number | 1457463010
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Entity Type | Individual
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Provider Name | ALBERTO DOMINGUEZ BALI MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 777 E 25TH ST SUITE 203
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City | HIALEAH
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State | FL
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Zip | 33013-3825
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Country | US
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Telephone | 305-693-3535
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Fax | 305-693-3565
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Provider Business Mailing Address
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Address Line | 19195 MYSTIC POINTE DR SUITE 2107
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City | AVENTURA
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State | FL
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Zip | 33180-4502
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Country | US
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Telephone | 305-693-3535
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Fax | 305-693-3565
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME 79533
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License Number State | FL
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