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1124391545 NPI number — DIANE WALLACE KOSHLAND C.M.T

NPI Number: 1124391545
Health Care Provider/Practitioner: DIANE WALLACE KOSHLAND C.M.T

Information about “1124391545” NPI (DIANE WALLACE KOSHLAND C.M.T) exists in 1124391545 in HTML format HTML  |  1124391545 in plain Text format TXT  |  1124391545 in PDF (Portable Document Format) PDF  |  1124391545 in an XML format XML  formats.

NPI Number : 1124391545 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124391545",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KOSHLAND",
    "FirstName": "DIANE",
    "MiddleName": "WALLACE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "C.M.T",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "828 SAN PABLO AVE STE 104",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALBANY",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94706-1678",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "828 SAN PABLO AVE STE 104",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALBANY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94706-1678",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "925-963-1405",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/15/2012",
    "LastUpdateDate": "02/15/2012",
    "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": "225700000X",
        "TaxonomyName": "Massage Therapist",
        "LicenseNumber": "10396",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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