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1063926103 NPI number — LISA ANTIONETTE BLAZIO CATC I

NPI Number: 1063926103
Health Care Provider/Practitioner: LISA ANTIONETTE BLAZIO CATC I

Information about “1063926103” NPI (LISA ANTIONETTE BLAZIO CATC I) exists in 1063926103 in HTML format HTML  |  1063926103 in plain Text format TXT  |  1063926103 in PDF (Portable Document Format) PDF  |  1063926103 in an XML format XML  formats.

NPI Number : 1063926103 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063926103",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLAZIO",
    "FirstName": "LISA",
    "MiddleName": "ANTIONETTE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CATC I",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3828 W CARSON ST STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TORRANCE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90503-6702",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-787-1335",
    "MailingAddressFaxNumber": "562-987-4586",
    "FirstLinePracticeLocationAddress": "3828 W CARSON ST STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TORRANCE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90503-6702",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-787-1335",
    "PracticeLocationAddressFaxNumber": "562-987-4586",
    "EnumerationDate": "11/28/2017",
    "LastUpdateDate": "01/07/2025",
    "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": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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