{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "MELISA A. ERICK, M.D., INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 4148",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TORRANCE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90510-4148",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-792-3914",
"MailingAddressFaxNumber": "855-885-2617",
"FirstLinePracticeLocationAddress": "4445 MAGNOLIA AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIVERSIDE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92501-4135",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-788-3000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/26/2013",
"LastUpdateDate": "04/05/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ERICK",
"AuthorizedOfficialFirstName": "MELISA",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "951-660-9535",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207L00000X",
"TaxonomyName": "Anesthesiology Physician",
"LicenseNumber": "G64088",
"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."
}
}
}
}