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General NPI Number Information
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NPI Number | 1699576587
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Entity Type | Organization
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Legal Business Name | PUEBLO CARE LLC
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 109 E 17TH ST STE 6178
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City | CHEYENNE
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State | WY
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Zip | 82001-4543
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Country | US
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Telephone | 720-761-1362
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Fax |
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Provider Business Mailing Address
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Address Line | 109 E 17TH ST STE 6178
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City | CHEYENNE
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State | WY
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Zip | 82001-4543
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Country | US
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Telephone | 720-761-1362
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MARIO RAFAEL ANGLADA CORTES
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Credential |
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Telephone | 720-761-1362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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