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General NPI Number Information
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NPI Number | 1649333162
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Entity Type | Organization
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Legal Business Name | ALRA
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/19/2009
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Provider Practice Location Address
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Address Line | 3658 BOONE PARK AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32205-9031
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Country | US
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Telephone | 904-384-0447
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Fax | 904-384-0447
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Provider Business Mailing Address
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Address Line | 3658 BOONE PARK AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32205-9031
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Country | US
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Telephone | 904-384-0447
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Fax | 904-384-0447
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Authorized Official
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Title or Position | OWNER
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Name | MR. AL RAMOS
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Credential | RPSGT
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Telephone | 904-384-0447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC3852
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License Number State | FL
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