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General NPI Number Information
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NPI Number | 1942949649
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Entity Type | Organization
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Legal Business Name | PROMED HEALTHCARE CLINIC LLC
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 11400 W FLAGLER ST STE 202
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City | MIAMI
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State | FL
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Zip | 33174-4007
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Country | US
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Telephone | 305-548-1118
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Fax | 786-558-5697
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Provider Business Mailing Address
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Address Line | 11400 W FLAGLER ST STE 202
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City | MIAMI
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State | FL
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Zip | 33174-4007
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Country | US
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Telephone | 305-548-1118
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Fax | 786-558-5697
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Authorized Official
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Title or Position | OWNER
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Name | MAGALY TRAVIESO
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Credential |
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Telephone | 305-639-8095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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