{
"Npi": {
"NPI": "1083149819",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "NAZER",
"FirstName": "ELLIE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "NAZERZADEH",
"OtherFirstName": "ELAHEHNAZER",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "150 VALPREDA RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN MARCOS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92069-2973",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-736-6767",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "619 CROUCH ST STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OCEANSIDE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92054-4460",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-736-6767",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/30/2017",
"LastUpdateDate": "12/15/2025",
"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": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "33853",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}