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General NPI Number Information
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NPI Number | 1801941281
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Entity Type | Individual
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Provider Name | RUTH BAUTISTA DIAZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 4870 W CLARK RD SUITE 107
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City | YPSILANTI
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State | MI
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Zip | 48197-1104
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Country | US
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Telephone | 734-434-7260
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Fax | 734-434-7607
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Provider Business Mailing Address
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Address Line | 45 E LEWIS AVE
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City | MILAN
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State | MI
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Zip | 48160-1119
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Country | US
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Telephone | 734-439-2303
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Fax | 734-439-0016
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301035476
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License Number State | MI
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