{
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"OrgName": "TRINITY AZEVEDO BLITT, INC",
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"FirstLineMailingAddress": "1501 FRONT ST",
"SecondLineMailingAddress": "UNIT 302",
"MailingAddressCityName": "SAN DIEGO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92101-2973",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-756-8456",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6037 LA GRANADA",
"SecondLinePracticeLocationAddress": "SUITE D",
"PracticeLocationAddressCityName": "RANCHO SANTA FE",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "858-759-8922",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/24/2016",
"LastUpdateDate": "03/02/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLITT",
"AuthorizedOfficialFirstName": "TRINITY",
"AuthorizedOfficialMiddleName": "AZEVEDO",
"AuthorizedOfficialTitle": "OWNER/AUDIOLOGIST",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "AU.D.",
"AuthorizedOfficialTelephoneNumber": "209-756-8456",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "237600000X",
"TaxonomyName": "Audiologist-Hearing Aid Fitter",
"LicenseNumber": "AU 3077",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}