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General NPI Number Information
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NPI Number | 1609615178
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Entity Type | Organization
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Legal Business Name | TRIDENT WOUND CARE LLC
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Dates
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Enumeration Date | 05/23/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 2365 FORREST RD
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City | WINTER PARK
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State | FL
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Zip | 32789
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Country | US
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Telephone | 407-790-0439
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Fax |
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Provider Business Mailing Address
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Address Line | 2365 FORREST RD
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City | WINTER PARK
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State | FL
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Zip | 32789
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Country | US
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Telephone | 407-790-0439
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. LEONARDO CISNEROS
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Credential | D.O.
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Telephone | 407-790-0439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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