NPI Code Detail JSON Logo

1295117489 NPI number — JESSICA CASTELLANOS-DIAZ MD

NPI Number: 1295117489
Health Care Provider/Practitioner: JESSICA CASTELLANOS-DIAZ MD

Information about “1295117489” NPI (JESSICA CASTELLANOS-DIAZ MD) exists in 1295117489 in HTML format HTML  |  1295117489 in plain Text format TXT  |  1295117489 in PDF (Portable Document Format) PDF  |  1295117489 in an XML format XML  formats.

NPI Number : 1295117489 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295117489",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CASTELLANOS-DIAZ",
    "FirstName": "JESSICA",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "47 5TH ST NW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WINTER HAVEN",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33881-4672",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "866-234-8534",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "130 RIDGE CENTER DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAVENPORT",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33837-6413",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "866-234-8534",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/24/2015",
    "LastUpdateDate": "04/20/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "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": "31658",
          "LicenseNumberStateCode": "PR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RE0101X",
          "TaxonomyName": "Endocrinology, Diabetes & Metabolism Physician",
          "LicenseNumber": "25915",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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