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General NPI Number Information
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NPI Number | 1861409898
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Entity Type | Organization
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Legal Business Name | FFV ID MED GROUP PSC
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 BOULEVARD RAMALLO
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City | SAN JUAN
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State | PR
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Zip | 00936-6372
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Country | US
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Telephone | 787-748-3818
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Fax |
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Provider Business Mailing Address
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Address Line | 300 BOULEVARD RAMALLO CARR 1 OFF 213
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City | SAN JUAN
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State | PR
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Zip | 00936-6372
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Country | US
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Telephone | 787-748-3818
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | MAYRA VELEZ RIVERA
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Credential |
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Telephone | 787-748-3818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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