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General NPI Number Information
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NPI Number | 1629788153
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Entity Type | Organization
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Legal Business Name | VISTA CARDIOVASCULAR INNOVATIONS, LLC
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 3904 CORTEZ RD W STE 300
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City | BRADENTON
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State | FL
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Zip | 34210-3204
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Country | US
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Telephone | 941-545-8954
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Fax |
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Provider Business Mailing Address
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Address Line | 3904 CORTEZ RD W STE 300
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City | BRADENTON
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State | FL
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Zip | 34210-3204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ENRIQUE RIVERA
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Credential | MD
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Telephone | 941-545-8954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease 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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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