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General NPI Number Information
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NPI Number | 1922726116
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Entity Type | Individual
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Provider Name | LUIGI ANGELO REGALADO LORENZO
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Gender | Male
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 527 5TH AVE #500
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City | SHEPPARD AFB
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State | TX
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Zip | 76311
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Country | US
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Telephone | 228-376-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 WEEKS PARK LN APT 405
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City | WICHITA FALLS
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State | TX
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Zip | 76308-3268
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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