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1386050805 NPI number — JONATHAN AVALOS M.D.

NPI Number: 1386050805
Health Care Provider/Practitioner: JONATHAN AVALOS M.D.

Information about “1386050805” NPI (JONATHAN AVALOS M.D.) exists in 1386050805 in HTML format HTML  |  1386050805 in plain Text format TXT  |  1386050805 in PDF (Portable Document Format) PDF  |  1386050805 in an XML format XML  formats.

NPI Number : 1386050805 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386050805",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "AVALOS",
    "FirstName": "JONATHAN",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "303 E VANDERBILT WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN BERNARDINO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92415-0026",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-601-4220",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "850 E FOOTHILL BLVD DEPT OF",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIALTO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92376-5230",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-601-4220",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/03/2014",
    "LastUpdateDate": "01/14/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207QA0401X",
        "TaxonomyName": "Addiction Medicine (Family Medicine) Physician",
        "LicenseNumber": "A139612",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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