NPI Code Detail JSON Logo

1346563871 NPI number — MARIETTA MARIBEL BREAUX PA-C

NPI Number: 1346563871
Health Care Provider/Practitioner: MARIETTA MARIBEL BREAUX PA-C

Information about “1346563871” NPI (MARIETTA MARIBEL BREAUX PA-C) exists in 1346563871 in HTML format HTML  |  1346563871 in plain Text format TXT  |  1346563871 in PDF (Portable Document Format) PDF  |  1346563871 in an XML format XML  formats.

NPI Number : 1346563871 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346563871",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BREAUX",
    "FirstName": "MARIETTA",
    "MiddleName": "MARIBEL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "20917 E MESARICA RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COVINA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91724-3313",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "626-384-0726",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12401 WASHINGTON BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WHITTIER",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90602-1006",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "626-384-0726",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/11/2010",
    "LastUpdateDate": "12/02/2021",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA20576",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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