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General NPI Number Information
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NPI Number | 1609229525
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Entity Type | Individual
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Provider Name | JOSUE MALDONADO CUSTODIO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 700 WEST AVE S
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City | LA CROSSE
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State | WI
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Zip | 54601-4783
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Country | US
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Telephone | 608-785-0940
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 860912
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-0912
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Country | US
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Telephone | 507-284-2511
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | S8070
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 85856-20
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License Number State | WI
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