{
"Npi": {
"NPI": "1396830204",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INTERNIST LABORATORY",
"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": "4980 CARROLL CANYON RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN DIEGO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92121-1736",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "858-638-8120",
"MailingAddressFaxNumber": "858-638-8298",
"FirstLinePracticeLocationAddress": "10200 PIONEER BLVD",
"SecondLinePracticeLocationAddress": "SUITE 500",
"PracticeLocationAddressCityName": "SANTA FE SPRINGS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90670-6000",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-906-5227",
"PracticeLocationAddressFaxNumber": "562-906-6450",
"EnumerationDate": "10/04/2006",
"LastUpdateDate": "08/06/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NICHOLSON",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "E.",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "562-906-5227",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": "CLF 2678",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}