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General NPI Number Information
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NPI Number | 1972156289
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Entity Type | Organization
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Legal Business Name | BON SALUT ORGANIC MED SPA
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 14846 TAMIAMI TRL
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City | NORTH PORT
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State | FL
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Zip | 34287-2701
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Country | US
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Telephone | 941-876-3577
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Fax |
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Provider Business Mailing Address
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Address Line | 14846 TAMIAMI TRL
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City | NORTH PORT
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State | FL
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Zip | 34287-2701
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Country | US
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Telephone | 941-876-3577
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OWNER
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Name | MRS. ANNE MARIE FARAG
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Credential |
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Telephone | 727-692-9465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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