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General NPI Number Information
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NPI Number | 1730947698
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Entity Type | Organization
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Legal Business Name | MY VIRTUAL CLINIC, LLC
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 1890 S OCEAN DR APT 1703
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-7735
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Country | US
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Telephone | 786-682-4084
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Fax |
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Provider Business Mailing Address
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Address Line | 1890 S OCEAN DR APT 1703
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-7735
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Country | US
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Telephone | 786-682-4084
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOSE LUIS RIVERA MENDEZ
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Credential | MD
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Telephone | 786-682-4084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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