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General NPI Number Information
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NPI Number | 1972931319
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Entity Type | Organization
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Legal Business Name | PROMISE MEDICAL P.S.C.
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Dates
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Enumeration Date | 10/22/2013
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Last Update Date | 10/22/2013
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Provider Practice Location Address
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Address Line | MAIN AVE 12-54
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City | BAYAMON
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State | PR
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Zip | 00959-9998
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Country | US
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Telephone | 787-251-7614
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Fax | 787-251-7608
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Provider Business Mailing Address
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Address Line | PO BOX 8929
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City | BAYAMON
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State | PR
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Zip | 00960-8929
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Country | US
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Telephone | 787-251-7614
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Fax | 787-251-7608
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. ANTHONY R RIVERA
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Credential | MD
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Telephone | 787-251-7614
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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 | 014466
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License Number State | PR
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