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General NPI Number Information
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NPI Number | 1669200382
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Entity Type | Individual
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Provider Name | MADELAINE MARTINEZ MORENO
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Gender | Female
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Dates
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Enumeration Date | 07/24/2024
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 790 NW 107TH AVE STE 110
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City | MIAMI
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State | FL
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Zip | 33172-3100
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Country | US
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Telephone | 305-964-5426
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Fax | 305-964-5627
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Provider Business Mailing Address
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Address Line | 9890 NW 4TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6103
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Country | US
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Telephone | 754-257-0313
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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