NPI Code Detail JSON Logo

1053298422 NPI number — AJAH-CHRISTINE DENISE FAMBO-DEMARTEAU PHD, AAP, VAIDYA

NPI Number: 1053298422
Health Care Provider/Practitioner: AJAH-CHRISTINE DENISE FAMBO-DEMARTEAU PHD, AAP, VAIDYA

Information about “1053298422” NPI (AJAH-CHRISTINE DENISE FAMBO-DEMARTEAU PHD, AAP, VAIDYA) exists in 1053298422 in HTML format HTML  |  1053298422 in plain Text format TXT  |  1053298422 in PDF (Portable Document Format) PDF  |  1053298422 in an XML format XML  formats.

NPI Number : 1053298422 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053298422",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FAMBO-DEMARTEAU",
    "FirstName": "AJAH-CHRISTINE",
    "MiddleName": "DENISE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD, AAP, VAIDYA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FAMBO-DEMARTEAU",
    "OtherFirstName": "DENISE",
    "OtherMiddleName": "CHRISTINE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PHD, AAP, VAIDYA , C",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "13900 MARQUESAS WAY APT 3109",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MARINA DEL REY",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90292-6024",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "431-059-3304",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "26877 SNOWMASS LOOP",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VALENCIA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91381-2408",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-593-3304",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/18/2025",
    "LastUpdateDate": "08/18/2025",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133N00000X",
          "TaxonomyName": "Nutritionist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133NN1002X",
          "TaxonomyName": "Nutrition Education Nutritionist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171400000X",
          "TaxonomyName": "Health & Wellness Coach",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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