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General NPI Number Information
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NPI Number | 1861970865
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Entity Type | Organization
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Legal Business Name | WIND RIVER MEDICAL GROUP INC.
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 06/05/2020
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Provider Practice Location Address
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Address Line | 900 W 49TH ST STE 300
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City | HIALEAH
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State | FL
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Zip | 33012-3407
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Country | US
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Telephone | 305-726-8997
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Fax |
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Provider Business Mailing Address
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Address Line | 900 W 49TH ST STE 300
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City | HIALEAH
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State | FL
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Zip | 33012-3407
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Country | US
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Telephone | 305-726-8997
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOEL NAVEIRA
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Credential |
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Telephone | 305-726-8997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | FL
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