1093277659 NPI number — FOTI EVANGELISTA ATC, CAT(C), AT

NPI Number: 1093277659
Health Care Provider/Practitioner: FOTI EVANGELISTA ATC, CAT(C), AT

NPI Number : 1093277659 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093277659",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EVANGELISTA",
    "FirstName": "FOTI",
    "MiddleName": null,
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "ATC, CAT(C), AT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "691 PIERRE STREET",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAVAL",
    "MailingAddressStateName": "QUEBEC",
    "MailingAddressPostalCode": "H7X3P4",
    "MailingAddressCountryCode": "CA",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2801 W. BANCROFT ST.",
    "SecondLinePracticeLocationAddress": "HEALTH AND HUMAN SERVICES RM 2505L, MAIL STOP 119",
    "PracticeLocationAddressCityName": "TOLEDO",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "43606-3390",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "419-530-4241",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/03/2019",
    "LastUpdateDate": "10/23/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "AT006015",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "2-5536",
          "LicenseNumberStateCode": "ZZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "2000034460",
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}