1215060009 NPI number — CHARLES NATHANIEL SHEDRICK C.A.T.S.

NPI Number: 1215060009
Health Care Provider/Practitioner: CHARLES NATHANIEL SHEDRICK C.A.T.S.

NPI Number : 1215060009 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215060009",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHEDRICK",
    "FirstName": "CHARLES",
    "MiddleName": "NATHANIEL",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "C.A.T.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "909 N AZUSA AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AZUSA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91702-2408",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "818-207-5808",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3085 RIDGEVIEW DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALTADENA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91001-4527",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "626-791-0831",
    "PracticeLocationAddressFaxNumber": "626-791-1592",
    "EnumerationDate": "03/13/2007",
    "LastUpdateDate": "03/08/2011",
    "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": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "030806",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}