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General NPI Number Information
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NPI Number | 1497742316
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Entity Type | Individual
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Provider Name | JOSE SANDALIO RIVERA IRIZARRY M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 211 CALLE MORSE
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City | ARROYO
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State | PR
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Zip | 00714-2350
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Country | US
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Telephone | 787-839-3980
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Fax | 787-271-2515
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Provider Business Mailing Address
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Address Line | 339 CYPRESS PKWY STE 110
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City | KISSIMMEE
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State | FL
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Zip | 34759-3315
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Country | US
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Telephone | 407-343-5000
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Fax | 407-343-5199
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 11901
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License Number State | PR
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