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General NPI Number Information
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NPI Number | 1912989286
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Entity Type | Organization
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Legal Business Name | SEVILLE ALLERGY AND ASTHMA CENTER, P.A.
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 245 E INTENDENCIA ST
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City | PENSACOLA
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State | FL
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Zip | 32502-6022
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Country | US
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Telephone | 850-437-0477
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Fax | 805-470-0805
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Provider Business Mailing Address
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Address Line | 245 E INTENDENCIA ST
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City | PENSACOLA
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State | FL
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Zip | 32502-6022
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Country | US
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Telephone | 850-437-0477
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Fax | 805-470-0805
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES D. PRESTI
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Credential | M.D.
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Telephone | 850-437-0477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME51062
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License Number State | FL
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