{
"Npi": {
"NPI": "1124690730",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HAUSMANN",
"FirstName": "ROGER",
"MiddleName": "DANA",
"NamePrefix": "MR.",
"NameSuffix": "II",
"Credential": "PHARMACY TECHNICIAN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HAUSMANN",
"OtherFirstName": "DANA",
"OtherMiddleName": null,
"OtherNamePrefix": "MR.",
"OtherNameSuffix": null,
"OtherCredential": "PHARMACY TECHNICIAN",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "2620 EL CAMINO REAL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA CLARA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95051-3041",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "408-241-0919",
"MailingAddressFaxNumber": "408-241-1202",
"FirstLinePracticeLocationAddress": "2620 EL CAMINO REAL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SANTA CLARA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95051-3041",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "408-241-0919",
"PracticeLocationAddressFaxNumber": "408-241-1202",
"EnumerationDate": "07/13/2021",
"LastUpdateDate": "07/13/2021",
"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": "183700000X",
"TaxonomyName": "Pharmacy Technician",
"LicenseNumber": "159365",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}