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General NPI Number Information
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NPI Number | 1700295094
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Entity Type | Organization
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Legal Business Name | PONCE PFT AND MEDICAL SERVICES, INC.
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 21110 BISCAYNE BLVD., SUITE 303
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City | AVENTURA
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State | FL
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Zip | 33180
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Country | US
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Telephone | 786-236-8899
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Fax |
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Provider Business Mailing Address
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Address Line | 335 S BISCAYNE BLVD APT 2210
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City | MIAMI
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State | FL
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Zip | 33131-2331
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Country | US
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Telephone | 786-236-8899
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CARLOS EFRAIN PONCE
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Credential | CRT
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Telephone | 786-236-8899
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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 | TN23815
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number | TT919
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License Number State | FL
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