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General NPI Number Information
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NPI Number | 1548479603
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Entity Type | Organization
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Legal Business Name | UNIVERSAL
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6500 WEST 4 AVE SUIT 35
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 305-512-1619
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Fax | 305-512-1621
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Provider Business Mailing Address
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Address Line | 6500 WEST 4 AVE SUIT 35
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 305-512-1619
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Fax | 305-512-1621
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ARMANDO HERNANDEZ
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Credential | OWNER
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Telephone | 305-934-4286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | HCC6579
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License Number State | FL
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