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1134781792 NPI number — DANIEL MAX & MARCANDREA LLC

NPI Number: 1134781792
Health Care Provider/Practitioner: DANIEL MAX & MARCANDREA LLC

Information about “1134781792” NPI (DANIEL MAX & MARCANDREA LLC) exists in 1134781792 in HTML format HTML  |  1134781792 in plain Text format TXT  |  1134781792 in PDF (Portable Document Format) PDF  |  1134781792 in an XML format XML  formats.

NPI Number : 1134781792 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134781792",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DANIEL MAX & MARCANDREA LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3801 S CONGRESS AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PALM SPRINGS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33461-4140",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4619 S HULEN ST, SUITE C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT WORTH",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76132",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "682-200-3879",
    "PracticeLocationAddressFaxNumber": "561-828-8367",
    "EnumerationDate": "07/03/2019",
    "LastUpdateDate": "02/22/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BENNETT",
    "AuthorizedOfficialFirstName": "JACKIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CREDENTIALING MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "561-612-4531",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "332H00000X",
        "TaxonomyName": "Eyewear Supplier",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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