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General NPI Number Information
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NPI Number | 1851102610
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Entity Type | Individual
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Provider Name | VICTOR MANUEL RODRIGUEZ
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Gender | Male
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 39 CIMARRON
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City | LAKE ELMO
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State | MN
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Zip | 55042-9617
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Country | US
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Telephone | 945-230-2062
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Fax |
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Provider Business Mailing Address
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Address Line | 39 CIMARRON
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City | LAKE ELMO
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State | MN
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Zip | 55042-9617
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Country | US
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Telephone | 945-230-2062
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | C000-152-726-100
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License Number State | MN
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