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General NPI Number Information
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NPI Number | 1871883165
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Entity Type | Organization
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Legal Business Name | GRUPO MEDICO CAROLINA, LLC
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | VILLA CAROLINA 35-21 CALLE 16
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City | CAROLINA
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State | PR
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Zip | 00985-5440
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Country | US
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Telephone | 787-752-1979
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Fax | 787-276-6299
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Provider Business Mailing Address
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Address Line | PLAZA CAROLINA ST P O BOX 9067
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City | CAROLINA
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State | PR
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Zip | 00988-9067
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Country | US
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Telephone | 787-752-1979
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Fax | 787-276-6299
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DIOGENES ORESTES ADAMES ROA
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Credential | M.D
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Telephone | 787-752-1979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | HPSM-0540
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License Number State | PR
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