{
"Npi": {
"NPI": "1407253446",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RIVERSIDE REGIONAL SURGERY CENTER INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4234 RIVERWALK PKWY",
"SecondLineMailingAddress": "STE 160",
"MailingAddressCityName": "RIVERSIDE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92505-8510",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-785-7772",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4234 RIVERWALK PKWY",
"SecondLinePracticeLocationAddress": "STE 160",
"PracticeLocationAddressCityName": "RIVERSIDE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92505-8510",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-785-7772",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/19/2014",
"LastUpdateDate": "12/16/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IQBAL",
"AuthorizedOfficialFirstName": "BABAR",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "951-785-7772",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP3300X",
"TaxonomyName": "Pain Clinic/Center",
"LicenseNumber": "A104410",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}