NPI Code Detail JSON Logo

1104330570 NPI number — INTEGRATED PSYCHIATRY, INC.

NPI Number: 1104330570
Health Care Provider/Practitioner: INTEGRATED PSYCHIATRY, INC.

Information about “1104330570” NPI (INTEGRATED PSYCHIATRY, INC.) exists in 1104330570 in HTML format HTML  |  1104330570 in plain Text format TXT  |  1104330570 in PDF (Portable Document Format) PDF  |  1104330570 in an XML format XML  formats.

NPI Number : 1104330570 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104330570",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "INTEGRATED PSYCHIATRY, INC.",
    "LastName": null,
    "FirstName": null,
    "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": "27943 SECO CANYON RD # 573",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SANTA CLARITA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91350-3872",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "818-927-0688",
    "MailingAddressFaxNumber": "866-543-9915",
    "FirstLinePracticeLocationAddress": "25000 AVENUE STANFORD STE 173",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VALENCIA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91355-4596",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "818-927-0688",
    "PracticeLocationAddressFaxNumber": "818-888-5982",
    "EnumerationDate": "11/21/2017",
    "LastUpdateDate": "02/04/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GRAYSON",
    "AuthorizedOfficialFirstName": "LOURDES",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "818-927-0688",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084A0401X",
          "TaxonomyName": "Addiction Medicine (Psychiatry & Neurology) Physician",
          "LicenseNumber": "A111804",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0005X",
          "TaxonomyName": "Neurodevelopmental Disabilities Physician",
          "LicenseNumber": "A111804",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "A111804",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0804X",
          "TaxonomyName": "Child & Adolescent Psychiatry Physician",
          "LicenseNumber": "A111804",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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