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1043310246 NPI number — NITHYA VENUGOPAL DMD

NPI Number: 1043310246
Health Care Provider/Practitioner: NITHYA VENUGOPAL DMD

Information about “1043310246” NPI (NITHYA VENUGOPAL DMD) exists in 1043310246 in HTML format HTML  |  1043310246 in plain Text format TXT  |  1043310246 in PDF (Portable Document Format) PDF  |  1043310246 in an XML format XML  formats.

NPI Number : 1043310246 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043310246",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VENUGOPAL",
    "FirstName": "NITHYA",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7138 BRONTE PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RANCHO CUCAMONGA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91701-8590",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "859-494-6421",
    "MailingAddressFaxNumber": "859-494-6421",
    "FirstLinePracticeLocationAddress": "68555 RAMON RD STE D101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CATHEDRAL CITY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92234-3310",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-384-6022",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/25/2006",
    "LastUpdateDate": "06/16/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "122300000X",
        "TaxonomyName": "Dentist",
        "LicenseNumber": "59930",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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