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General NPI Number Information
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NPI Number | 1982689147
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Entity Type | Individual
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Provider Name | JESUS VELASQUEZ MALLARI M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 5483 PAPAGALLO DR
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City | OCEANSIDE
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State | CA
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Zip | 92057-1907
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Country | US
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Telephone | 760-231-1611
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Fax |
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Provider Business Mailing Address
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Address Line | 3551 ROGER BROOKE DR
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-539-9582
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301047321
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License Number State | FM
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301047321
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License Number State | MI
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