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1184062309 NPI number — JOHNATHAN RYAN TAITANO DO

NPI Number: 1184062309
Health Care Provider/Practitioner: JOHNATHAN RYAN TAITANO DO

Information about “1184062309” NPI (JOHNATHAN RYAN TAITANO DO) exists in 1184062309 in HTML format HTML  |  1184062309 in plain Text format TXT  |  1184062309 in PDF (Portable Document Format) PDF  |  1184062309 in an XML format XML  formats.

NPI Number : 1184062309 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1184062309",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TAITANO",
    "FirstName": "JOHNATHAN",
    "MiddleName": "RYAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2610 S JONES BLVD STE 1",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89146-5635",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "702-723-8314",
    "MailingAddressFaxNumber": "702-895-7776",
    "FirstLinePracticeLocationAddress": "2208 S NELLIS BLVD STE 5",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAS VEGAS",
    "PracticeLocationAddressStateName": "NV",
    "PracticeLocationAddressPostalCode": "89104-6211",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "702-798-7770",
    "PracticeLocationAddressFaxNumber": "702-895-7776",
    "EnumerationDate": "06/10/2013",
    "LastUpdateDate": "10/13/2025",
    "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": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "DO2144",
          "LicenseNumberStateCode": "NV",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "174400000X",
          "TaxonomyName": "Specialist",
          "LicenseNumber": "SL0955",
          "LicenseNumberStateCode": "NV",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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