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1023368164 NPI number — PRIME PEDIATRIC ASSOCIATES, LLC

NPI Number: 1023368164
Health Care Provider/Practitioner: PRIME PEDIATRIC ASSOCIATES, LLC

Information about “1023368164” NPI (PRIME PEDIATRIC ASSOCIATES, LLC) exists in 1023368164 in HTML format HTML  |  1023368164 in plain Text format TXT  |  1023368164 in PDF (Portable Document Format) PDF  |  1023368164 in an XML format XML  formats.

NPI Number : 1023368164 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023368164",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PRIME PEDIATRIC ASSOCIATES, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "100 E SAMPLE RD",
    "SecondLineMailingAddress": "STE 120",
    "MailingAddressCityName": "POMPANO BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33064-3554",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-941-2021",
    "MailingAddressFaxNumber": "954-941-2071",
    "FirstLinePracticeLocationAddress": "100 E SAMPLE RD",
    "SecondLinePracticeLocationAddress": "STE 120",
    "PracticeLocationAddressCityName": "POMPANO BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33064-3554",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-941-2021",
    "PracticeLocationAddressFaxNumber": "954-941-2071",
    "EnumerationDate": "09/17/2012",
    "LastUpdateDate": "09/17/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "VASQUEZ",
    "AuthorizedOfficialFirstName": "DIBANNI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MGRM",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "305-972-1073",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208000000X",
        "TaxonomyName": "Pediatrics Physician",
        "LicenseNumber": "ME109534",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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