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General NPI Number Information
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NPI Number | 1508670514
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Entity Type | Individual
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Provider Name | MOIRA DEL MAR GONZALEZ SAMOT DC
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Gender | Female
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 403 JOAN AVE N
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City | LEHIGH ACRES
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State | FL
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Zip | 33971-1941
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Country | US
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Telephone | 239-369-9109
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Fax |
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Provider Business Mailing Address
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Address Line | 705 CHRISTINA LAKE DR
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City | LAKELAND
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State | FL
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Zip | 33813-3571
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Country | US
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Telephone | 787-989-3686
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH15261
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License Number State | FL
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