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General NPI Number Information
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NPI Number | 1861231987
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Entity Type | Individual
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Provider Name | PATRICIO ELIAS CASTILLA
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Gender | Male
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/25/2024
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Provider Practice Location Address
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Address Line | 230 MAPLE ST
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City | HOLYOKE
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State | MA
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Zip | 01040-5144
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Country | US
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Telephone | 413-420-1755
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Fax |
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Provider Business Mailing Address
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Address Line | 11031 NE 9TH AVE
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City | BISCAYNE PARK
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State | FL
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Zip | 33161-7227
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Country | US
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Telephone | 305-322-6779
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | PENDING
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License Number State | MA
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