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General NPI Number Information
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NPI Number | 1699855643
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Entity Type | Organization
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Legal Business Name | FAUSTINO F DEGRO
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 8104 CALLE CONCORDIA SUITE #1
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City | PONCE
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State | PR
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Zip | 00717-1541
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Country | US
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Telephone | 787-844-6410
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Fax | 787-840-6168
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Provider Business Mailing Address
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Address Line | PO BOX 331651
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City | PONCE
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State | PR
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Zip | 00733-1651
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Country | US
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Telephone | 787-844-6410
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Fax | 787-840-6168
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | MS. LOURDES MARTINEZ
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Credential | MT
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Telephone | 787-844-6410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 450
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License Number State | PR
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