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1174560619 NPI number — ID PROFESSIONALS OF SOUTH FLORIDA LLC

NPI Number: 1174560619
Health Care Provider/Practitioner: ID PROFESSIONALS OF SOUTH FLORIDA LLC

Information about “1174560619” NPI (ID PROFESSIONALS OF SOUTH FLORIDA LLC) exists in 1174560619 in HTML format HTML  |  1174560619 in plain Text format TXT  |  1174560619 in PDF (Portable Document Format) PDF  |  1174560619 in an XML format XML  formats.

NPI Number : 1174560619 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174560619",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ID PROFESSIONALS OF SOUTH FLORIDA LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 371082",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIAMI",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33137-1082",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "305-698-5997",
    "MailingAddressFaxNumber": "305-698-5998",
    "FirstLinePracticeLocationAddress": "1790 W 49TH ST",
    "SecondLinePracticeLocationAddress": "SUITE 400-9",
    "PracticeLocationAddressCityName": "HIALEAH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33012-2992",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "305-698-5997",
    "PracticeLocationAddressFaxNumber": "305-698-5998",
    "EnumerationDate": "06/01/2006",
    "LastUpdateDate": "01/22/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LOPEZ",
    "AuthorizedOfficialFirstName": "MARIO",
    "AuthorizedOfficialMiddleName": "R.",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "954-495-5102",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RI0200X",
        "TaxonomyName": "Infectious Disease Physician",
        "LicenseNumber": "ME75291",
        "LicenseNumberStateCode": "FL",
        "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."
      }
    }
  }
}
                
            

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