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General NPI Number Information
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NPI Number | 1982994075
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Entity Type | Organization
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Legal Business Name | KALAGA PA
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 18126 PRESTONSHIRE
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4473
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Country | US
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Telephone | 210-844-7575
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Fax | 210-493-8297
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Provider Business Mailing Address
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Address Line | 18126 PRESTONSHIRE
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4473
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Country | US
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Telephone | 210-844-7575
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Fax | 210-493-8297
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Authorized Official
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Title or Position | OWNER
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Name | MARIO E. RUIZ
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Credential | MD
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Telephone | 210-844-7575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | K1917
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License Number State | TX
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