{
"Npi": {
"NPI": "1336836436",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PINA",
"FirstName": "KELLY",
"MiddleName": null,
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PINA",
"OtherFirstName": "KELLY",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "23502 LYONS AVE STE 304A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA CLARITA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91321-2538",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "661-702-0166",
"MailingAddressFaxNumber": "661-702-0169",
"FirstLinePracticeLocationAddress": "23502 LYONS AVE STE 304A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SANTA CLARITA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91321-2538",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "661-702-0166",
"PracticeLocationAddressFaxNumber": "661-702-0169",
"EnumerationDate": "04/19/2023",
"LastUpdateDate": "04/19/2023",
"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": "111NI0013X",
"TaxonomyName": "Independent Medical Examiner Chiropractor",
"LicenseNumber": "106S00000X",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "106S00000X",
"TaxonomyName": "Behavior Technician",
"LicenseNumber": "106S00000X",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}