{
"Npi": {
"NPI": "1336544097",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "IGLESIAS",
"FirstName": "LAURA",
"MiddleName": "C",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LOZANO",
"OtherFirstName": "LAURA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "4050 W METROPOLITAN DR STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ORANGE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92868-3502",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-401-3931",
"MailingAddressFaxNumber": "888-403-6922",
"FirstLinePracticeLocationAddress": "950 E STATE HIGHWAY 114 STE 160",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTHLAKE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76092-5261",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-401-3931",
"PracticeLocationAddressFaxNumber": "888-403-6922",
"EnumerationDate": "10/23/2014",
"LastUpdateDate": "09/01/2021",
"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": "103K00000X",
"TaxonomyName": "Behavior Analyst",
"LicenseNumber": "4278",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "103K00000X",
"TaxonomyName": "Behavior Analyst",
"LicenseNumber": "1-14-9744",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}