NPI Code Detail JSON Logo

1104038769 NPI number — KRISTIN ANNE PENA AUD

NPI Number: 1104038769
Health Care Provider/Practitioner: KRISTIN ANNE PENA AUD

Information about “1104038769” NPI (KRISTIN ANNE PENA AUD) exists in 1104038769 in HTML format HTML  |  1104038769 in plain Text format TXT  |  1104038769 in PDF (Portable Document Format) PDF  |  1104038769 in an XML format XML  formats.

NPI Number : 1104038769 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104038769",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PENA",
    "FirstName": "KRISTIN",
    "MiddleName": "ANNE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "AUD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SLIFER",
    "OtherFirstName": "KRISTIN",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "6700 WASHINGTON AVE S",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EDEN PRAIRIE",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55344-3405",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "800-328-8602",
    "MailingAddressFaxNumber": "952-285-3980",
    "FirstLinePracticeLocationAddress": "23822 VALENCIA BLVD STE 103",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SANTA CLARITA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91355-5303",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "661-253-3277",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/04/2007",
    "LastUpdateDate": "07/11/2022",
    "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": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "0000791",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "237600000X",
          "TaxonomyName": "Audiologist-Hearing Aid Fitter",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "237700000X",
          "TaxonomyName": "Hearing Instrument Specialist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "AU3469",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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