{
"Npi": {
"NPI": "1265772081",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CYPRESS PEDIATRICS, 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": "200 W ESPLANADE AVE STE 314",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KENNER",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70065-2489",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "504-305-5500",
"MailingAddressFaxNumber": "504-305-5038",
"FirstLinePracticeLocationAddress": "200 W ESPLANADE AVE STE 314",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KENNER",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70065-2489",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "504-305-5500",
"PracticeLocationAddressFaxNumber": "504-305-5038",
"EnumerationDate": "02/15/2013",
"LastUpdateDate": "07/20/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FOTI",
"AuthorizedOfficialFirstName": "KAREN",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "504-251-1000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "MD 25481",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}