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General NPI Number Information
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NPI Number | 1811260748
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Entity Type | Individual
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Provider Name | MARYURI ENID LOPEZ SANTANA MA
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Gender | Female
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 12021 PIONEERS WAY APT 1118
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City | ORLANDO
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State | FL
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Zip | 32832-2802
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Country | US
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Telephone | 713-894-1614
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Fax | 407-264-6421
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Provider Business Mailing Address
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Address Line | 12055 SABO RD 432
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City | HOUSTON
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State | TX
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Zip | 77089-6282
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Country | US
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Telephone | 832-208-2051
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Fax |
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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 | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 35884
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License Number State | TX
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