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General NPI Number Information
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NPI Number | 1558219295
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Entity Type | Individual
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Provider Name | ANGELITA YOVANNI CARRASCO
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Gender | Female
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 1144 CENTER ST NE
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City | SALEM
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State | OR
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Zip | 97301-2523
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Country | US
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Telephone | 503-363-2021
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Fax |
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Provider Business Mailing Address
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Address Line | 1529 WILTSEY RD SE
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City | SALEM
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State | OR
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Zip | 97306-8510
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Country | US
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Telephone | 971-301-9395
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Fax |
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 26-CRM-5138
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License Number State | OR
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