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General NPI Number Information
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NPI Number | 1811419880
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Entity Type | Organization
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Legal Business Name | TRUSTED CARE SAN ANTONIO NW LLC
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 2116 BABCOCK RD
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4411
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Country | US
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Telephone | 602-715-1654
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Fax | 602-715-1654
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Provider Business Mailing Address
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Address Line | 20430 N 19TH AVE STE B145
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City | PHOENIX
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State | AZ
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Zip | 85027-3588
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Country | US
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Telephone | 210-202-0288
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | WAYNE DESTEFANO
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Credential |
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Telephone | 602-715-1654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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