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General NPI Number Information
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NPI Number | 1790984474
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Entity Type | Organization
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Legal Business Name | INSTITUTO MEDICO DEL DOLOR Y MEDICINA COMPLEMENTARIA
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 652 MUNOZ RIVERA AVE. MONTE MALL BLDG SUITE 2070
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City | SAN JUAN
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State | PR
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Zip | 00918-4149
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Country | US
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Telephone | 787-293-3223
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Fax | 787-759-3000
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Provider Business Mailing Address
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Address Line | 652 MUNOZ RIVERA AVE. MONTE MALL BLDG SUITE 2070
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City | SAN JUAN
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State | PR
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Zip | 00918-4149
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Country | US
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Telephone | 787-293-3223
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Fax | 787-759-3000
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAMUL E TORRES CASTRO
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Credential | M.D.
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Telephone | 787-296-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 165, 10076
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License Number State | PR
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