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General NPI Number Information
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NPI Number | 1558772905
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Entity Type | Organization
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Legal Business Name | MY OWN HOSPICE LLC
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 8207 CALLAGHAN RD STE 400A
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City | SAN ANTONIO
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State | TX
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Zip | 78230-4735
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Country | US
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Telephone | 210-988-1461
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Fax | 210-404-9887
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Provider Business Mailing Address
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Address Line | 6900 SW 80TH ST
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City | MIAMI
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State | FL
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Zip | 33143-4931
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Country | US
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Telephone | 305-591-1606
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Fax | 305-591-1618
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | ISMAEL ROQUE-VELASCO
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Credential |
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Telephone | 305-591-1606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 018026
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License Number State | TX
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