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General NPI Number Information
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NPI Number | 1487946174
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Entity Type | Organization
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Legal Business Name | INOVATIVE MEDICALGROUPINC
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | BOULERVARD DEL RIO #2
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City | SAN JUAN
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State | PR
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Zip | 00928-5129
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Country | US
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Telephone | 787-429-4407
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 25129
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City | SAN JUAN
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State | PR
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Zip | 00928-5129
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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 | PRESIDENTE
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Name | DR. JOSE M LOPEZ
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Credential | MD
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Telephone | 787-429-4407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 2846
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License Number State | PR
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