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1114390564 NPI number — GUSTAVE KRUMM

NPI Number: 1114390564
Health Care Provider/Practitioner: GUSTAVE KRUMM

Information about “1114390564” NPI (GUSTAVE KRUMM) exists in 1114390564 in HTML format HTML  |  1114390564 in plain Text format TXT  |  1114390564 in PDF (Portable Document Format) PDF  |  1114390564 in an XML format XML  formats.

NPI Number : 1114390564 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114390564",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KRUMM",
    "FirstName": "GUSTAVE",
    "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": "PO BOX 160862",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SACRAMENTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95816-0862",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "916-806-0286",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1550 JULIESSE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SACRAMENTO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95815-1803",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "916-921-6598",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/06/2015",
    "LastUpdateDate": "11/06/2015",
    "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": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "K0509301006",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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