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General NPI Number Information
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NPI Number | 1710023767
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Entity Type | Individual
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Provider Name | ANGELO GUILLERMO PEZZAROSSI MD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1100 ALAMEDA BLVD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114
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Country | US
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Telephone | 505-792-4465
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Fax | 505-792-8578
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Provider Business Mailing Address
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Address Line | PO BOX 16068
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City | ALBUQUERQUE
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State | NM
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Zip | 87191-6068
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Country | US
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Telephone | 505-792-4465
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Fax | 505-792-8578
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | NM7581
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License Number State | NM
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