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General NPI Number Information
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NPI Number | 1699709824
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Entity Type | Organization
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Legal Business Name | DIALYSIS PARTNERS 1 INC.
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 220 KISSIMMEE PARK RD
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1547
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Country | US
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Telephone | 407-498-0018
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Fax |
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Provider Business Mailing Address
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Address Line | 220 KISSIMMEE PARK RD
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1547
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Country | US
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Telephone | 407-498-0018
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JORGE A LARRANAGA
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Credential | M.D.
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Telephone | 407-498-0018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 06155284
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License Number State | FL
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