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General NPI Number Information
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NPI Number | 1518191576
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Entity Type | Organization
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Legal Business Name | ALFONSO PROFESSIONAL MEDICAL CTR
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 05/06/2009
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Provider Practice Location Address
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Address Line | 11180 W FLAGLER STREET STE 13
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City | MIAMI
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State | FL
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Zip | 33174-1215
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Country | US
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Telephone | 305-480-8473
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Fax | 305-480-8472
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Provider Business Mailing Address
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Address Line | 11180 W FLAGLER ST STE 13
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City | MIAMI
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State | FL
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Zip | 33174-1216
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Country | US
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Telephone | 305-480-8473
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Fax | 305-480-8472
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Authorized Official
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Title or Position | OWNER
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Name | MR. JUAN CARLOS ALFONSO
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Credential | MA
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Telephone | 305-480-8473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | MA 42956
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License Number State | FL
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