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General NPI Number Information
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NPI Number | 1942874557
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Entity Type | Organization
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Legal Business Name | PARADISE VALLEY MEDICAL GROUP
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 14631 N CAVE CREEK RD STE 101
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City | PHOENIX
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State | AZ
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Zip | 85022-4100
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Country | US
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Telephone | 480-828-0143
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Fax |
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Provider Business Mailing Address
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Address Line | 14631 N CAVE CREEK RD STE 101
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City | PHOENIX
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State | AZ
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Zip | 85022-4100
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Country | US
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Telephone |
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Fax | 602-429-8108
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Authorized Official
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Title or Position | OWNER
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Name | LORENA SULEYMANOVA
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Credential |
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Telephone | 480-828-0143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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