{
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "ALFREDO BIMBELA",
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"FirstLineMailingAddress": "1500 PALMA DR FL 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VENTURA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93003-6451",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-284-1783",
"MailingAddressFaxNumber": "888-958-5269",
"FirstLinePracticeLocationAddress": "3585 MAPLE ST STE 233",
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"PracticeLocationAddressCityName": "VENTURA",
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"PracticeLocationAddressTelephoneNumber": "805-284-1783",
"PracticeLocationAddressFaxNumber": "888-958-5269",
"EnumerationDate": "12/15/2017",
"LastUpdateDate": "05/24/2021",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BIMBELA",
"AuthorizedOfficialFirstName": "ALFREDO",
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"AuthorizedOfficialCredential": "PHD, FNP, PHMHNP",
"AuthorizedOfficialTelephoneNumber": "805-284-1783",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "15951",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}