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General NPI Number Information
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NPI Number | 1942486527
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Entity Type | Individual
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Provider Name | ALEJANDRA MARIA MAYORGA M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 1364 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-1059
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Country | US
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Telephone | 404-712-4583
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11550 APT. 1214
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City | MIAMI
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State | FL
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Zip | 33101-1550
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Country | US
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Telephone | 305-674-2680
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Fax | 305-674-3919
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 59464
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License Number State | GA
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