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General NPI Number Information
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NPI Number | 1528855343
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Entity Type | Organization
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Legal Business Name | MEDIVITAL HEALTH CENTER LLC
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 10550 NW 77TH CT STE 305
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City | HIALEAH
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State | FL
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Zip | 33016-2071
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Country | US
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Telephone | 786-782-7738
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Fax | 833-523-2326
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Provider Business Mailing Address
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Address Line | 10540 NW 78TH ST APT 424
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City | DORAL
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State | FL
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Zip | 33178-6089
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Country | US
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Telephone | 305-764-9170
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Fax | 833-523-2326
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Authorized Official
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Title or Position | OWNER
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Name | ADRIANA BAEZ
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Credential |
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Telephone | 305-764-9170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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