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General NPI Number Information
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NPI Number | 1669067237
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Entity Type | Individual
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Provider Name | ROEL CRISOSTOMO MANGAOANG
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Gender | Male
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 601 UNIVERSE BLVD
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City | JUNO BEACH
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State | FL
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Zip | 33408-2444
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Country | US
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Telephone | 561-627-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 239 BEVERLY RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33405-4729
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Country | US
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Telephone | 754-152-4310
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Fax |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT7009
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License Number State | FL
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