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General NPI Number Information
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NPI Number | 1821328048
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Entity Type | Organization
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Legal Business Name | PROACTIVE MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 1951 SW 172ND AVE SUITE 210
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City | MIRAMAR
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State | FL
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Zip | 33029-5593
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Country | US
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Telephone | 786-223-5669
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Fax |
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Provider Business Mailing Address
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Address Line | 1951 SW 172ND AVE SUITE 210
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City | MIRAMAR
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State | FL
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Zip | 33029-5593
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Country | US
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Telephone | 786-223-5669
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. OLGA LUCIA MARTINEZ
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Credential |
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Telephone | 786-223-5369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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