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Individual

RAUL LAZARO VEGA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
803 OAK ST, GREEN COVE SPRINGS, FL 32043-4317
(904) 284-5606
Mailing address
11630 W RIDE DR, JACKSONVILLE, FL 32223-7452
(786) 301-9745

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
29739
FL

Other

Enumeration date
10/25/2019
Last updated
10/25/2019
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