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1396259362 NPI number — RONALD K GOLDBERG MD INC

NPI Number: 1396259362
Health Care Provider/Practitioner: RONALD K GOLDBERG MD INC

Information about “1396259362” NPI (RONALD K GOLDBERG MD INC) exists in 1396259362 in HTML format HTML  |  1396259362 in plain Text format TXT  |  1396259362 in PDF (Portable Document Format) PDF  |  1396259362 in an XML format XML  formats.

NPI Number : 1396259362 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396259362",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "RONALD K GOLDBERG MD INC",
    "ParentOrgTIN": null,
    "OrgName": "RONALD K GOLDBERG MD INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5565 GROSSMONT CENTER DR STE 455",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LA MESA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91942-3073",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "619-462-9353",
    "MailingAddressFaxNumber": "619-462-6935",
    "FirstLinePracticeLocationAddress": "5565 GROSSMONT CENTER DR STE 455",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LA MESA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91942-3073",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "619-462-9353",
    "PracticeLocationAddressFaxNumber": "619-462-6935",
    "EnumerationDate": "11/28/2017",
    "LastUpdateDate": "11/28/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HANSEN",
    "AuthorizedOfficialFirstName": "JENNIFER",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRACTICE ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "619-462-9353",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RC0000X",
        "TaxonomyName": "Cardiovascular Disease Physician",
        "LicenseNumber": "G65437",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "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."
      }
    }
  }
}
                
            

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