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General NPI Number Information
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NPI Number | 1780860668
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Entity Type | Organization
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Legal Business Name | MEDCHOICE OF WEST HIALEAH LLC
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 1255 W 46TH ST SUITE 8
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City | HIALEAH
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State | FL
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Zip | 33012-3283
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Country | US
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Telephone | 305-828-0048
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Fax | 305-828-2639
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Provider Business Mailing Address
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Address Line | PO BOX 141799
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City | CORAL GABLES
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State | FL
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Zip | 33144-1799
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Country | US
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Telephone | 305-828-0048
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Fax | 305-828-2639
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA DIAZ
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Credential | DO
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Telephone | 305-828-0048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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