{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "PHYSICIAN MOBILE SERVICES INC.",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"OtherLastName": null,
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"FirstLineMailingAddress": "3419 VIA LIDO # 513",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEWPORT BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92663-3908",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-544-7489",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2700 NEWPORT BLVD STE 164",
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"PracticeLocationAddressCityName": "NEWPORT BEACH",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressTelephoneNumber": "562-544-7489",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/29/2020",
"LastUpdateDate": "03/29/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MUNGUIA",
"AuthorizedOfficialFirstName": "JOSEPH",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "562-544-7489",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}