{
"Npi": {
"NPI": "1043637986",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GANZON",
"FirstName": "DAX",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OT R/L",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8421 STARLILY CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ELK GROVE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95758-1321",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-346-2529",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8421 STARLILY CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ELK GROVE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95758-1321",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-346-2529",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/27/2014",
"LastUpdateDate": "03/27/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225X00000X",
"TaxonomyName": "Occupational Therapist",
"LicenseNumber": "OT 8552",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "225XG0600X",
"TaxonomyName": "Gerontology Occupational Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225XM0800X",
"TaxonomyName": "Mental Health Occupational Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225XN1300X",
"TaxonomyName": "Neurorehabilitation Occupational Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225XP0019X",
"TaxonomyName": "Physical Rehabilitation Occupational Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}