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General NPI Number Information
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NPI Number | 1538802681
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Entity Type | Organization
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Legal Business Name | MAVENVA PROFESSIONALS
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Dates
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Enumeration Date | 04/17/2022
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Last Update Date | 04/17/2022
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Provider Practice Location Address
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Address Line | 3728 DACOMA ST STE 145
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City | HOUSTON
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State | TX
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Zip | 77092-8906
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Country | US
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Telephone | 737-256-7350
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Fax |
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Provider Business Mailing Address
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Address Line | 3728 DACOMA ST STE 145
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City | HOUSTON
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State | TX
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Zip | 77092-8906
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PERSONNEL
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Name | BACK OFFICE
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Credential |
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Telephone | 737-256-7350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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