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1043669872 NPI number — ENAY MANUEL BAZO JACOMINO

NPI Number: 1043669872
Health Care Provider/Practitioner: ENAY MANUEL BAZO JACOMINO

Information about “1043669872” NPI (ENAY MANUEL BAZO JACOMINO) exists in 1043669872 in HTML format HTML  |  1043669872 in plain Text format TXT  |  1043669872 in PDF (Portable Document Format) PDF  |  1043669872 in an XML format XML  formats.

NPI Number : 1043669872 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043669872",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BAZO JACOMINO",
    "FirstName": "ENAY",
    "MiddleName": "MANUEL",
    "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": "19801 SW 110TH CT APT 220",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CUTLER BAY",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33157-8448",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "305-764-1458",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "19801 SW 110TH CT APT 220",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CUTLER BAY",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33157-8448",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "305-764-1458",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/13/2016",
    "LastUpdateDate": "06/13/2016",
    "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": "103K00000X",
        "TaxonomyName": "Behavior Analyst",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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