{
"Npi": {
"NPI": "1053321406",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CERDA",
"FirstName": "MARTHA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "R.P.T., PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "446 CADBROOK DRIVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LA PUENTE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91744-3715",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-330-1440",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7212 ORANGETHORPE AVE",
"SecondLinePracticeLocationAddress": "SUITE # 3",
"PracticeLocationAddressCityName": "BUENA PARK",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90621-3341",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-562-0966",
"PracticeLocationAddressFaxNumber": "888-789-3197",
"EnumerationDate": "08/08/2006",
"LastUpdateDate": "02/05/2010",
"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": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT 18734",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA 15320",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}