{
"Npi": {
"NPI": "1245791490",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "QUEST HEALTH MANAGEMENT PSYCHOLOGICAL CORPORATION",
"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": "4110 EDISON AVE STE 206A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHINO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91710-8417",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-454-5577",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4110 EDISON AVE STE 206A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHINO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91710-8417",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-454-5577",
"PracticeLocationAddressFaxNumber": "951-599-7511",
"EnumerationDate": "03/29/2019",
"LastUpdateDate": "05/24/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABERRA",
"AuthorizedOfficialFirstName": "TSEDAY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGING DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PSY.D.",
"AuthorizedOfficialTelephoneNumber": "951-454-5577",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}