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1205244688 NPI number — IRVING GONZALEZ

NPI Number: 1205244688
Health Care Provider/Practitioner: IRVING GONZALEZ

Information about “1205244688” NPI (IRVING GONZALEZ) exists in 1205244688 in HTML format HTML  |  1205244688 in plain Text format TXT  |  1205244688 in PDF (Portable Document Format) PDF  |  1205244688 in an XML format XML  formats.

NPI Number : 1205244688 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205244688",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GONZALEZ",
    "FirstName": "IRVING",
    "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": "2604 S EMERALD AVE",
    "SecondLineMailingAddress": "APARTMENT C",
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60616-2525",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-791-0240",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1921 DAVIS AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WHITING",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46394-1820",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "219-659-3522",
    "PracticeLocationAddressFaxNumber": "219-554-4571",
    "EnumerationDate": "07/29/2014",
    "LastUpdateDate": "07/29/2014",
    "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": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "36002219A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "096003543",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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