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General NPI Number Information
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NPI Number | 1861988016
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Entity Type | Organization
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Legal Business Name | VICIOSO MEDICAL AND ADDICTION SERVICES LLC
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 7261 SHERIDAN ST STE 100D
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City | HOLLYWOOD
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State | FL
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Zip | 33024-2708
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Country | US
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Telephone | 954-534-7696
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Fax |
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Provider Business Mailing Address
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Address Line | 5729 LIVE OAK TER
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-6377
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Country | US
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Telephone | 646-808-5915
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | DR. LUIS E VICIOSO
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Credential | MD
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Telephone | 646-808-5915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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