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General NPI Number Information
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NPI Number | 1629133251
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Entity Type | Organization
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Legal Business Name | ADVANCE PRO-HEALTH, CORP.
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | BOULEVARD MONROIG AVE. Y-30
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-261-1363
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Fax | 787-261-1563
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Provider Business Mailing Address
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Address Line | PO BOX 52192
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City | TOA BAJA
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State | PR
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Zip | 00950-2192
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Country | US
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Telephone | 787-261-1363
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Fax | 787-261-1563
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANGEL LUIS COMULADA
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Credential | MD
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Telephone | 787-261-1363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 12569
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License Number State | PR
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