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General NPI Number Information
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NPI Number | 1760684971
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Entity Type | Organization
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Legal Business Name | CENTRO MEDICO BORINQUEN INC
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | CALLE 1 A-5 ALTOS URB. CONDADO MODERNO
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-648-7171
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Fax | 787-961-6086
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Provider Business Mailing Address
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Address Line | 15341 SW 20TH ST
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City | MIRAMAR
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State | FL
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Zip | 33027-4379
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Country | US
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Telephone | 305-300-1577
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Fax | 305-779-6969
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | REBECCA CAIRO
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Credential |
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Telephone | 305-300-1577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | FL
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