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General NPI Number Information
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NPI Number | 1508255415
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Entity Type | Individual
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Provider Name | MASSIEL R. MENA M.D.HSE
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Gender | Female
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 1330 BUDINGER AVE
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City | SAINT CLOUD
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State | FL
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Zip | 34769-4137
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Country | US
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Telephone | 407-891-2010
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Fax | 407-891-8211
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Provider Business Mailing Address
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Address Line | 2715 ASHLEY CT
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City | KISSIMMEE
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State | FL
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Zip | 34743-5346
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Country | US
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Telephone | 407-552-2677
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Fax |
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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 | 156FX1100X
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Taxonomy Name | Ophthalmic Technician/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | HSE41308
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 480-05
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License Number State | ZZ
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