{
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"IsOrgSubpart": "N",
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"OrgName": "MOUTAZ ALMAWALDI MD PC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "5120 HILL RD E",
"SecondLineMailingAddress": "PO BOX 1917",
"MailingAddressCityName": "LAKEPORT",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95453-6300",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "707-263-4766",
"MailingAddressFaxNumber": "707-263-4771",
"FirstLinePracticeLocationAddress": "5120 HILL RD E",
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"PracticeLocationAddressCityName": "LAKEPORT",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "707-263-4766",
"PracticeLocationAddressFaxNumber": "707-263-4771",
"EnumerationDate": "02/05/2008",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALMAWALDI",
"AuthorizedOfficialFirstName": "MOHAMAD MOUTAZ",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "707-263-4766",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RN0300X",
"TaxonomyName": "Nephrology Physician",
"LicenseNumber": "A49796",
"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."
}
}
}
}