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General NPI Number Information
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NPI Number | 1659282572
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Entity Type | Individual
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Provider Name | SAMUEL SPINAZZOLA
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Gender | Male
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 4212 SE DIVISION ST STE 100
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City | PORTLAND
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State | OR
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Zip | 97206-1628
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Country | US
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Telephone | 503-238-0706
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Fax | 503-236-7166
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Provider Business Mailing Address
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Address Line | 847 NE 19TH AVE STE 100
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City | PORTLAND
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State | OR
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Zip | 97232-2684
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Country | US
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Telephone | 503-674-7777
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Fax | 503-235-6049
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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 | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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