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General NPI Number Information
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NPI Number | 1528392321
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Entity Type | Individual
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Provider Name | JUAN CARLOS L PEREZ LOZADA M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 05/31/2015
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Provider Practice Location Address
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Address Line | 20 YORK ST SPC 2-213
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City | NEW HAVEN
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State | CT
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Zip | 06510-3220
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Country | US
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Telephone | 203-785-7026
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Fax | 203-737-1077
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Provider Business Mailing Address
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Address Line | 20 YORK ST SPC 2-213
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City | NEW HAVEN
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State | CT
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Zip | 06510-3220
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Country | US
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Telephone | 203-785-7026
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Fax | 203-737-1077
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 051271
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 051271
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License Number State | CT
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