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General NPI Number Information
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NPI Number | 1750674412
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Entity Type | Individual
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Provider Name | RUPERTO CASTANEDA VALLARTA JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 211 NW LARCH AVE
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City | REDMOND
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State | OR
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Zip | 97756-1357
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Country | US
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Telephone | 541-548-2164
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Fax | 541-548-0534
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Provider Business Mailing Address
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Address Line | PO BOX 5579
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City | BEND
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State | OR
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Zip | 97708-5579
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Country | US
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Telephone | 541-548-2164
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Fax | 541-548-0534
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD166206
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License Number State | OR
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