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1174492425 NPI number — JADYN STEPHANIE DE BRUYN

NPI Number: 1174492425
Health Care Provider/Practitioner: JADYN STEPHANIE DE BRUYN

Information about “1174492425” NPI (JADYN STEPHANIE DE BRUYN) exists in 1174492425 in HTML format HTML  |  1174492425 in plain Text format TXT  |  1174492425 in PDF (Portable Document Format) PDF  |  1174492425 in an XML format XML  formats.

NPI Number : 1174492425 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174492425",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DE BRUYN",
    "FirstName": "JADYN",
    "MiddleName": "STEPHANIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DE BRUYN",
    "OtherFirstName": "JADE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "1943 LAUREL WOOD CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "THOUSAND OAKS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91362-1208",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "805-443-4222",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "100 N LAKEVIEW CANYON RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WESTLAKE VILLAGE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91362-3802",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "805-497-6711",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/04/2025",
    "LastUpdateDate": "11/04/2025",
    "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": "171400000X",
        "TaxonomyName": "Health & Wellness Coach",
        "LicenseNumber": "71B66CDF53",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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