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1053921619 NPI number — AMONISE MONDESTIN

NPI Number: 1053921619
Health Care Provider/Practitioner: AMONISE MONDESTIN

Information about “1053921619” NPI (AMONISE MONDESTIN) exists in 1053921619 in HTML format HTML  |  1053921619 in plain Text format TXT  |  1053921619 in PDF (Portable Document Format) PDF  |  1053921619 in an XML format XML  formats.

NPI Number : 1053921619 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053921619",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MONDESTIN",
    "FirstName": "AMONISE",
    "MiddleName": null,
    "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": "4600 CYPRESS KNEE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOCA RATON",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33487-2116",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "561-853-5260",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4600 CYPRESS KNEE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOCA RATON",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33487-2116",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "561-853-5260",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/07/2020",
    "LastUpdateDate": "08/07/2020",
    "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": "311Z00000X",
          "TaxonomyName": "Custodial Care Facility",
          "LicenseNumber": "6907014",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "311ZA0620X",
          "TaxonomyName": "Adult Care Home Facility",
          "LicenseNumber": "6907014",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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